Provider Demographics
NPI:1992995849
Name:LIU, CHING (MTOM)
Entity type:Individual
Prefix:
First Name:CHING
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11965 VENICE BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3954
Mailing Address - Country:US
Mailing Address - Phone:310-591-8786
Mailing Address - Fax:
Practice Address - Street 1:11965 VENICE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3954
Practice Address - Country:US
Practice Address - Phone:310-591-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10543171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist