Provider Demographics
NPI:1689833626
Name:LIU, YALI LO (LAC)
Entity Type:Individual
Prefix:MS
First Name:YALI
Middle Name:LO
Last Name:LIU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:DR
Other - First Name:YALI
Other - Middle Name:
Other - Last Name:LO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4950 HAMILTON AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-1750
Mailing Address - Country:US
Mailing Address - Phone:408-396-8811
Mailing Address - Fax:
Practice Address - Street 1:4950 HAMILTON AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95130-1750
Practice Address - Country:US
Practice Address - Phone:408-396-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA11796171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist