Healthcare Provider Details

I. General information

NPI: 1235371089
Provider Name (Legal Business Name): NANCY LIU LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 S MAIN ST
MILPITAS CA
95035-5302
US

IV. Provider business mailing address

143 S MAIN ST
MILPITAS CA
95035-5302
US

V. Phone/Fax

Practice location:
  • Phone: 408-935-8850
  • Fax: 408-935-8250
Mailing address:
  • Phone: 408-935-8850
  • Fax: 408-935-8250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: