Healthcare Provider Details

I. General information

NPI: 1356273973
Provider Name (Legal Business Name): ANDY LIEU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 N AVONDALE AVE STE 256
CHICAGO IL
60631-1993
US

IV. Provider business mailing address

7332 N LOWELL AVE
LINCOLNWOOD IL
60712-1926
US

V. Phone/Fax

Practice location:
  • Phone: 773-942-7339
  • Fax:
Mailing address:
  • Phone: 773-387-4095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198011988
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: