Healthcare Provider Details

I. General information

NPI: 1366378317
Provider Name (Legal Business Name): JUN JIE LIAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 PLEASANT ST
MALDEN MA
02148
US

IV. Provider business mailing address

210 PLEASANT ST
MALDEN MA
02148
US

V. Phone/Fax

Practice location:
  • Phone: 508-808-8878
  • Fax:
Mailing address:
  • Phone: 508-808-8878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number6014254
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: