Healthcare Provider Details

I. General information

NPI: 1487929543
Provider Name (Legal Business Name): DONG E LIU L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 GLENN AVE
SANTA MONICA CA
90405-5808
US

IV. Provider business mailing address

3011 GLENN AVE
SANTA MONICA CA
90405-5808
US

V. Phone/Fax

Practice location:
  • Phone: 310-367-9292
  • Fax:
Mailing address:
  • Phone: 310-367-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: