Provider Demographics
NPI:1124324231
Name:LIEU, HUNG TRIEU (LAC)
Entity type:Individual
Prefix:
First Name:HUNG
Middle Name:TRIEU
Last Name:LIEU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:HUNG
Other - Middle Name:
Other - Last Name:LIEU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:7782 UPPER 23RD ST N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5135
Mailing Address - Country:US
Mailing Address - Phone:651-983-7412
Mailing Address - Fax:
Practice Address - Street 1:1810 CREST VIEW DR STE 4A
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016
Practice Address - Country:US
Practice Address - Phone:651-983-7412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1540171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist