Provider Demographics
NPI:1023233061
Name:LIU, MENG (LAC)
Entity type:Individual
Prefix:MISS
First Name:MENG
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 KIOWA CREST DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2909
Mailing Address - Country:US
Mailing Address - Phone:909-860-1858
Mailing Address - Fax:
Practice Address - Street 1:399 E HIGHLAND AVE STE 502
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3872
Practice Address - Country:US
Practice Address - Phone:909-228-7359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4872171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC4872OtherACUPUNCTURE