Healthcare Provider Details

I. General information

NPI: 1699273664
Provider Name (Legal Business Name): ALLEN C LIU L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15040 VICTORY BLVD UNIT 201
VAN NUYS CA
91411-1825
US

IV. Provider business mailing address

15040 VICTORY BLVD UNIT 201
VAN NUYS CA
91411-1825
US

V. Phone/Fax

Practice location:
  • Phone: 213-590-5822
  • Fax:
Mailing address:
  • Phone: 213-590-5822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: