Healthcare Provider Details

I. General information

NPI: 1821323478
Provider Name (Legal Business Name): DR. LI SU LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 CLEGHORN DR UNIT F
DIAMOND BAR CA
91765-2324
US

IV. Provider business mailing address

1118 CLEGHORN DR UNIT F
DIAMOND BAR CA
91765-2324
US

V. Phone/Fax

Practice location:
  • Phone: 909-861-2328
  • Fax:
Mailing address:
  • Phone: 909-861-2328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: