Healthcare Provider Details

I. General information

NPI: 1295883874
Provider Name (Legal Business Name): SHIWEN LIU L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

17931 BEACH BLVD STE 214
HUNTINGTON BEACH CA
92647-7113
US

IV. Provider business mailing address

5122 LA PALMA AVE
LA PALMA CA
90623-1701
US

V. Phone/Fax

Practice location:
  • Phone: 714-229-1827
  • Fax:
Mailing address:
  • Phone: 714-229-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 7182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: