Basic Information
| Provider Information | |||||||||
| NPI: | 1003145566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIU | ||||||||
| FirstName: | JUN YI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LAC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 4055 COLLEGE POINT BLVD FL 2 | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113545169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9172852279 | ||||||||
| FaxNumber: | 7182286798 | ||||||||
| Practice Location | |||||||||
| Address1: | 4055 COLLEGE POINT BLVD FL 2 | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113545169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9172852279 | ||||||||
| FaxNumber: | 7182286798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2009 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | Y | Other Service Providers | Acupuncturist |
No ID Information.