Healthcare Provider Details

I. General information

NPI: 1710046586
Provider Name (Legal Business Name): LI-FANG LIAO L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22833 BOTHELL EVERETT HWY SUITE 144
BOTHELL WA
98021-9385
US

IV. Provider business mailing address

1420 141ST ST SW
LYNNWOOD WA
98087-6052
US

V. Phone/Fax

Practice location:
  • Phone: 425-483-8525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00001895
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: