Healthcare Provider Details

I. General information

NPI: 1972816759
Provider Name (Legal Business Name): HANAH LIU LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W MAIN ST 103
TUSTIN CA
92780
US

IV. Provider business mailing address

218 W MAIN ST 103
TUSTIN CA
92780
US

V. Phone/Fax

Practice location:
  • Phone: 949-412-6730
  • Fax: 213-402-2453
Mailing address:
  • Phone: 949-412-6730
  • Fax: 213-402-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: