Provider Demographics
NPI:1639438831
Name:CHIU, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CHIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 SANTA ROSA LN
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5476
Mailing Address - Country:US
Mailing Address - Phone:415-310-6059
Mailing Address - Fax:510-337-1812
Practice Address - Street 1:2431 SANTA ROSA LN
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5476
Practice Address - Country:US
Practice Address - Phone:415-310-6059
Practice Address - Fax:510-337-1812
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14675171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist