Healthcare Provider Details

I. General information

NPI: 1427609304
Provider Name (Legal Business Name): LINGGUANG LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 EAST HENNEPIN AVE SUITE 412
MINNEAPOLIS MN
55413
US

IV. Provider business mailing address

3710 GRAND WAY
ST. LOUIS PARK MN
55416
US

V. Phone/Fax

Practice location:
  • Phone: 612-379-3583
  • Fax: 952-746-7992
Mailing address:
  • Phone: 952-746-7992
  • Fax: 952-746-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1861
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: