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General NPI Number Information
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NPI Number | 1104245794
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Entity Type | Organization
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Legal Business Name | CLL HEALTH CARE CLINIC, LLC
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 527 W THAMES ST UNIT 23
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City | NORWICH
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State | CT
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Zip | 06360-7153
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Country | US
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Telephone | 203-271-7089
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Fax |
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Provider Business Mailing Address
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Address Line | 527 W THAMES ST UNIT 23
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City | NORWICH
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State | CT
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Zip | 06360-7153
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Country | US
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Telephone | 203-271-7089
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Fax |
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Authorized Official
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Title or Position | M.D.
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Name | DR. ZHENXIANG LIU
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Credential | M.D.
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Telephone | 203-271-7089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 048768
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License Number State | CT
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