Provider Demographics
NPI:1740045483
Name:LIU, HONGWEN (LAC)
Entity type:Individual
Prefix:
First Name:HONGWEN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 FREMONT HUB COURTYARD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-7702
Mailing Address - Country:US
Mailing Address - Phone:510-713-9086
Mailing Address - Fax:
Practice Address - Street 1:230 FREMONT HUB COURTYARD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-7702
Practice Address - Country:US
Practice Address - Phone:510-713-9086
Practice Address - Fax:510-713-8538
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20015171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist