Healthcare Provider Details

I. General information

NPI: 1366515397
Provider Name (Legal Business Name): HUIMIN LIU III LICENSE ACUPUNCTUER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 S DUNIVIN LN
DEWEY AZ
86327-6709
US

IV. Provider business mailing address

853 S DUNIVIN LN
DEWEY AZ
86327-6709
US

V. Phone/Fax

Practice location:
  • Phone: 818-640-9198
  • Fax:
Mailing address:
  • Phone: 818-640-9198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberL,AC 8969
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number011391
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: