MEDICARE: MS. YALI LO LIU LAC

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	A11796	CA

General Provider Information

NPI Number	:	1689833626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YALI LO LIU LAC

Provider Business Mailing Address
First Line	:	4950 HAMILTON AVE
Second Line	:	SUITE 106
City	:	SAN JOSE
State	:	CA
Zip	:	95130-1750
Country	:	US
Telephone Number	:	408-396-8811
Fax Number	:

Provider Business Practice Location Address
First Line	:	4950 HAMILTON AVE
Second Line	:	SUITE 106
City	:	SAN JOSE
State	:	CA
Zip	:	95130-1750
Country	:	US
Telephone Number	:	408-396-8811
Fax Number	:

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

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/05/2008

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