MEDICARE: MRS. YUANJUN LIU L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	198000257	IL

General Provider Information

NPI Number	:	1447490255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YUANJUN LIU L.AC

Provider Business Mailing Address
First Line	:	1417 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-3201
Country	:	US
Telephone Number	:	773-502-4164
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 W DIVERSEY PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1111
Country	:	US
Telephone Number	:	773-472-0700
Fax Number	:	773-472-0300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	03/06/2009

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