Provider Demographics
NPI:1891211231
Name:LIBERTY HEALTH MANAGEMENT CORP.
Entity Type:Organization
Organization Name:LIBERTY HEALTH MANAGEMENT CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:XIAOJUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-269-8732
Mailing Address - Street 1:121 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-5426
Mailing Address - Country:US
Mailing Address - Phone:650-588-8339
Mailing Address - Fax:650-588-8337
Practice Address - Street 1:121 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-5426
Practice Address - Country:US
Practice Address - Phone:650-588-8339
Practice Address - Fax:650-588-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11227171100000X
CAAC4278171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty