Healthcare Provider Details

I. General information

NPI: 1871507814
Provider Name (Legal Business Name): JIANGHUA LIU L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WILLOW LIU

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 BREA CANYON RD STE 158
DIAMOND BAR CA
91789-3005
US

IV. Provider business mailing address

680 BREA CANYON RD STE 158
DIAMOND BAR CA
91789-3005
US

V. Phone/Fax

Practice location:
  • Phone: 909-869-1999
  • Fax:
Mailing address:
  • Phone: 909-869-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 10885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: