Healthcare Provider Details

I. General information

NPI: 1255107595
Provider Name (Legal Business Name): AILAN LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 LAUREL ST
SAN CARLOS CA
94070-5217
US

IV. Provider business mailing address

1608 LAUREL ST
SAN CARLOS CA
94070-5217
US

V. Phone/Fax

Practice location:
  • Phone: 510-881-6292
  • Fax:
Mailing address:
  • Phone: 510-881-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC19859
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number41082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: