Healthcare Provider Details

I. General information

NPI: 1366088742
Provider Name (Legal Business Name): FEI LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 01/12/2020
Certification Date: 01/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 VINCENT PL
MC LEAN VA
22101-3615
US

IV. Provider business mailing address

1305 VINCENT PL
MC LEAN VA
22101-3615
US

V. Phone/Fax

Practice location:
  • Phone: 703-388-6996
  • Fax:
Mailing address:
  • Phone: 571-489-9501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000940
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: