Provider Demographics
NPI:1306180195
Name:LIU, GENGHONG III (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MS
First Name:GENGHONG
Middle Name:
Last Name:LIU
Suffix:III
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 ESTUDILLO AVE APT J
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4630
Mailing Address - Country:US
Mailing Address - Phone:510-816-1128
Mailing Address - Fax:
Practice Address - Street 1:579 ESTUDILLO AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4640
Practice Address - Country:US
Practice Address - Phone:510-816-1128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13797171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist