Healthcare Provider Details

I. General information

NPI: 1083919906
Provider Name (Legal Business Name): XU LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E LAS TUNAS DR STE 6
SAN GABRIEL CA
91776-1411
US

IV. Provider business mailing address

206 E LAS TUNAS DR STE 6
SAN GABRIEL CA
91776-1411
US

V. Phone/Fax

Practice location:
  • Phone: 626-285-2858
  • Fax: 626-285-2858
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 13504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: