Provider Demographics
NPI:1750180378
Name:LIU, MIMI SANGMO (DACM, LAC)
Entity type:Individual
Prefix:DR
First Name:MIMI
Middle Name:SANGMO
Last Name:LIU
Suffix:
Gender:
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 80TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1714
Mailing Address - Country:US
Mailing Address - Phone:917-208-9591
Mailing Address - Fax:
Practice Address - Street 1:59 E 54TH ST RM 22
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-9222
Practice Address - Country:US
Practice Address - Phone:917-208-9591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3208480171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist