Provider Demographics
NPI:1386905321
Name:LSACK, LI LIU (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:LI
Middle Name:LIU
Last Name:LSACK
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:LI
Other - Middle Name:LIU
Other - Last Name:ISACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACUPUNCTURIST
Mailing Address - Street 1:3088 HACIENDA DR
Mailing Address - Street 2:
Mailing Address - City:PEBBLE BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93953-2806
Mailing Address - Country:US
Mailing Address - Phone:415-244-0838
Mailing Address - Fax:
Practice Address - Street 1:3088 HACIENDA DR
Practice Address - Street 2:
Practice Address - City:PEBBLE BEACH
Practice Address - State:CA
Practice Address - Zip Code:93953-2806
Practice Address - Country:US
Practice Address - Phone:415-244-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13717171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist