Provider Demographics
NPI:1689815441
Name:LIU, TAI LI (LAC)
Entity Type:Individual
Prefix:MS
First Name:TAI LI
Middle Name:
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 1:1619 BROUGHAM PL
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-3769
Mailing Address - Country:US
Mailing Address - Phone:626-278-0891
Mailing Address - Fax:
Practice Address - Street 1:1619 BROUGHAM PL
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-3769
Practice Address - Country:US
Practice Address - Phone:626-278-0891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12899171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist