Healthcare Provider Details

I. General information

NPI: 1578570933
Provider Name (Legal Business Name): CHUANHAI LIU LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15865 GALE AVE STE B
HACIENDA HEIGHTS CA
91745-1643
US

IV. Provider business mailing address

1525 ELLESFORD AVE
ROWLAND HEIGHTS CA
91748-2219
US

V. Phone/Fax

Practice location:
  • Phone: 626-715-9298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: