Provider Demographics
NPI:1699273664
Name:LIU, ALLEN C (L AC)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:C
Last Name:LIU
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15040 VICTORY BLVD UNIT 201
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1825
Mailing Address - Country:US
Mailing Address - Phone:213-590-5822
Mailing Address - Fax:
Practice Address - Street 1:15040 VICTORY BLVD UNIT 201
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1825
Practice Address - Country:US
Practice Address - Phone:213-590-5822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17910171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist