Healthcare Provider Details

I. General information

NPI: 1932799129
Provider Name (Legal Business Name): LIY LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78-6831 ALII DR STE 201
KAILUA KONA HI
96740-5401
US

IV. Provider business mailing address

76-775 IO PL
KAILUA KONA HI
96740-9708
US

V. Phone/Fax

Practice location:
  • Phone: 808-940-1086
  • Fax:
Mailing address:
  • Phone: 808-940-1086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU-1243
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: