Healthcare Provider Details

I. General information

NPI: 1174830459
Provider Name (Legal Business Name): YU TANG LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 E SAXON AVE
SAN GABRIEL CA
91776-4238
US

IV. Provider business mailing address

621 E SAXON AVE
SAN GABRIEL CA
91776-4238
US

V. Phone/Fax

Practice location:
  • Phone: 626-823-1021
  • Fax:
Mailing address:
  • Phone: 626-823-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 13656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: