Healthcare Provider Details

I. General information

NPI: 1053482406
Provider Name (Legal Business Name): CHUN YANG LIU LAC OMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 GEARY BLVD STE 203
SAN FRANCISCO CA
94118-3251
US

IV. Provider business mailing address

1762 18TH AVE
SAN FRANCISCO CA
94122-4506
US

V. Phone/Fax

Practice location:
  • Phone: 415-379-9863
  • Fax: 415-681-2768
Mailing address:
  • Phone: 415-379-9863
  • Fax: 415-681-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: