Provider Demographics
NPI:1447490255
Name:LIU, YUANJUN (LAC)
Entity type:Individual
Prefix:MRS
First Name:YUANJUN
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 1:1417 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3201
Mailing Address - Country:US
Mailing Address - Phone:773-502-4164
Mailing Address - Fax:
Practice Address - Street 1:1425 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1111
Practice Address - Country:US
Practice Address - Phone:773-472-0700
Practice Address - Fax:773-472-0300
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000257171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist