Healthcare Provider Details

I. General information

NPI: 1548313505
Provider Name (Legal Business Name): RUI QIONG LIU L.AC.,O.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FRANKLIN ST SUIT 203
OAKLAND CA
94612-3219
US

IV. Provider business mailing address

1441 FRANKLIN ST SUIT 203
OAKLAND CA
94612-3219
US

V. Phone/Fax

Practice location:
  • Phone: 510-420-5787
  • Fax: 510-834-8658
Mailing address:
  • Phone: 510-420-5787
  • Fax: 510-834-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: