Healthcare Provider Details

I. General information

NPI: 1710057583
Provider Name (Legal Business Name): JING LIU L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EVELYN AVE. 115 PLAZA PROFESSIONAL BLDG.
ALBANY CA
94706
US

IV. Provider business mailing address

6063 MONTEREY AVE
RICHMOND CA
94805-1224
US

V. Phone/Fax

Practice location:
  • Phone: 510-527-1289
  • Fax:
Mailing address:
  • Phone: 510-527-1289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: