Provider Demographics
NPI:1215372412
Name:LIU, MINLIN (LAC)
Entity Type:Individual
Prefix:
First Name:MINLIN
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E 107TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3939
Mailing Address - Country:US
Mailing Address - Phone:212-534-1500
Mailing Address - Fax:212-860-8538
Practice Address - Street 1:127 E 107TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3939
Practice Address - Country:US
Practice Address - Phone:212-534-1500
Practice Address - Fax:212-860-8538
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004247171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist