Healthcare Provider Details

I. General information

NPI: 1295623015
Provider Name (Legal Business Name): AMANDA LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 COLORADO AVE STE 100
PALO ALTO CA
94303-3913
US

IV. Provider business mailing address

1979 STEPHENS LN
WOODLAND CA
95776-9321
US

V. Phone/Fax

Practice location:
  • Phone: 408-571-8839
  • Fax:
Mailing address:
  • Phone: 408-571-8839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: