Provider Demographics
NPI:1750729901
Name:LIU, HONGBO LILY (OMD, PHD)
Entity type:Individual
Prefix:DR
First Name:HONGBO
Middle Name:LILY
Last Name:LIU
Suffix:
Gender:F
Credentials:OMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4301
Mailing Address - Country:US
Mailing Address - Phone:314-374-2256
Mailing Address - Fax:
Practice Address - Street 1:7649 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-3910
Practice Address - Country:US
Practice Address - Phone:314-725-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012019018171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist