Healthcare Provider Details

I. General information

NPI: 1255763140
Provider Name (Legal Business Name): JINCHENG LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 SUNRISE AVE STE 800
ROSEVILLE CA
95661-4525
US

IV. Provider business mailing address

729 SUNRISE AVE STE 800
ROSEVILLE CA
95661-4525
US

V. Phone/Fax

Practice location:
  • Phone: 916-771-8388
  • Fax: 916-960-8978
Mailing address:
  • Phone: 916-771-8388
  • Fax: 916-960-8978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: