Provider Demographics
NPI:1417798083
Name:LIEU, KWAN (NBC-HWC, FMCHC, ISTT)
Entity type:Individual
Prefix:
First Name:KWAN
Middle Name:
Last Name:LIEU
Suffix:
Gender:F
Credentials:NBC-HWC, FMCHC, ISTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8717 DELGANY AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-6111
Mailing Address - Country:US
Mailing Address - Phone:626-636-6937
Mailing Address - Fax:
Practice Address - Street 1:8717 DELGANY AVE APT 306
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-6111
Practice Address - Country:US
Practice Address - Phone:626-636-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3887233171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach