Healthcare Provider Details

I. General information

NPI: 1336263391
Provider Name (Legal Business Name): BAOKU LIU L,AC.PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W 54TH ST SUITE 1-C
NEW YORK NY
10019-5500
US

IV. Provider business mailing address

205 W 54TH ST SUITE 1-C
NEW YORK NY
10019-5500
US

V. Phone/Fax

Practice location:
  • Phone: 212-397-8988
  • Fax: 212-397-8899
Mailing address:
  • Phone: 212-397-8988
  • Fax: 212-397-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000708
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: