Provider Demographics
NPI:1588036636
Name:LIU, ANG (LAC)
Entity Type:Individual
Prefix:MR
First Name:ANG
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 1:824 SUNSET BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-8834
Mailing Address - Country:US
Mailing Address - Phone:626-376-6660
Mailing Address - Fax:
Practice Address - Street 1:824 SUNSET BLVD APT A
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-8834
Practice Address - Country:US
Practice Address - Phone:626-376-6660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15069171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist