1649337601 NPI number — QUANZHI LIU OMD LAC

Table of content: QUANZHI LIU OMD LAC (NPI 1649337601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649337601 NPI number — QUANZHI LIU OMD LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIU
Provider First Name:
QUANZHI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OMD LAC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIU
Provider Other First Name:
MILTON
Provider Other Middle Name:
Q
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OMD LAC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1649337601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4350 N 19TH AVE
Provider Second Line Business Mailing Address:
#4
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-274-2592
Provider Business Mailing Address Fax Number:
602-246-0442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4350 N 19TH AVE
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-274-2592
Provider Business Practice Location Address Fax Number:
602-246-0442
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  0117 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1032697 . This is a "PROMIS ID AMERICAN SPECIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: MILLIU8795 . This is a "USER NAME FOR WHOLEHEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z6393 . This is a "PROVIDER #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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