Provider Demographics
NPI:1477030120
Name:LIU, STEVE (LAC)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 TEMPLE CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1564
Mailing Address - Country:US
Mailing Address - Phone:626-242-5658
Mailing Address - Fax:
Practice Address - Street 1:4050 TEMPLE CITY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1564
Practice Address - Country:US
Practice Address - Phone:626-242-5658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2255171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2255OtherLICENSE NUMBER
CA954772315OtherTEXT ID NUMBER