Healthcare Provider Details

I. General information

NPI: 1497001762
Provider Name (Legal Business Name): YUTING LIU L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 TISCH WAY STE 507
SAN JOSE CA
95128-2531
US

IV. Provider business mailing address

544 DUDLEY AVE APT 1
SAN JOSE CA
95128-2003
US

V. Phone/Fax

Practice location:
  • Phone: 408-260-0208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 14935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: