Provider Demographics
NPI:1538458880
Name:LIU, MARCIE SHUSEN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:SHUSEN
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 1:15871 REGALADO ST
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4777
Mailing Address - Country:US
Mailing Address - Phone:626-715-7173
Mailing Address - Fax:
Practice Address - Street 1:630 MISSION ST
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3058
Practice Address - Country:US
Practice Address - Phone:626-799-9888
Practice Address - Fax:626-799-9777
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14187171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist