Provider Demographics
NPI:1891262218
Name:LIU, JESSICA H (LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:H
Last Name:LIU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14115 28TH AVE APT 6E
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1614
Mailing Address - Country:US
Mailing Address - Phone:443-570-0175
Mailing Address - Fax:
Practice Address - Street 1:875 PARK AVE APT 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0382
Practice Address - Country:US
Practice Address - Phone:443-570-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006404171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist