Provider Demographics
NPI:1174707186
Name:LIU, BO (LAC)
Entity type:Individual
Prefix:
First Name:BO
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 1:400 CONTINENTAL CT
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4453
Mailing Address - Country:US
Mailing Address - Phone:805-375-0456
Mailing Address - Fax:
Practice Address - Street 1:610 S SERRANO AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2847
Practice Address - Country:US
Practice Address - Phone:213-448-4189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6095171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6095OtherACUPUNCTURE BOARD