Provider Demographics
NPI:1184949448
Name:LIU, KELAN (ACU)
Entity type:Individual
Prefix:
First Name:KELAN
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:ACU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2110
Mailing Address - Country:US
Mailing Address - Phone:818-386-0629
Mailing Address - Fax:818-386-0891
Practice Address - Street 1:4849 VAN NUYS BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2110
Practice Address - Country:US
Practice Address - Phone:818-386-0629
Practice Address - Fax:818-386-0891
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5784171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist