Healthcare Provider Details

I. General information

NPI: 1588036636
Provider Name (Legal Business Name): ANG LIU LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 SUNSET BLVD APT A
ARCADIA CA
91007-8834
US

IV. Provider business mailing address

824 SUNSET BLVD APT A
ARCADIA CA
91007-8834
US

V. Phone/Fax

Practice location:
  • Phone: 626-376-6660
  • Fax:
Mailing address:
  • Phone: 626-376-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 15069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: