Healthcare Provider Details

I. General information

NPI: 1316367550
Provider Name (Legal Business Name): HAI YING LIU CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43195 MISSION BLVD STE B5
FREMONT CA
94539-5340
US

IV. Provider business mailing address

43195 MISSION BLVD STE B5
FREMONT CA
94539-5340
US

V. Phone/Fax

Practice location:
  • Phone: 510-409-1065
  • Fax: 510-490-8199
Mailing address:
  • Phone: 510-409-1065
  • Fax: 510-490-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: