Provider Demographics
NPI:1649337601
Name:LIU, QUANZHI (OMD LAC)
Entity type:Individual
Prefix:
First Name:QUANZHI
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:OMD LAC
Other - Prefix:
Other - First Name:MILTON
Other - Middle Name:Q
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OMD LAC
Mailing Address - Street 1:4350 N 19TH AVE
Mailing Address - Street 2:#4
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015
Mailing Address - Country:US
Mailing Address - Phone:602-274-2592
Mailing Address - Fax:602-246-0442
Practice Address - Street 1:4350 N 19TH AVE
Practice Address - Street 2:#4
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015
Practice Address - Country:US
Practice Address - Phone:602-274-2592
Practice Address - Fax:602-246-0442
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0117171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1032697OtherPROMIS ID AMERICAN SPECIA
AZMILLIU8795OtherUSER NAME FOR WHOLEHEALTH
AZ1Z6393OtherPROVIDER #