Healthcare Provider Details

I. General information

NPI: 1447490255
Provider Name (Legal Business Name): YUANJUN LIU L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 W DIVERSEY PKWY
CHICAGO IL
60614-1111
US

IV. Provider business mailing address

1417 W HARRISON ST
CHICAGO IL
60607-3201
US

V. Phone/Fax

Practice location:
  • Phone: 773-472-0700
  • Fax: 773-472-0300
Mailing address:
  • Phone: 773-502-4164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198000257
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: