MEDICARE: RESOLUTE PHYSICIANS MEDICAL GROUP PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1104577808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESOLUTE PHYSICIANS MEDICAL GROUP PC

Provider Business Mailing Address
First Line	:	1650 JACKSON ST STE 101
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-3059
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 JACKSON ST STE 101
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-3059
Country	:	US
Telephone Number	:	415-858-0905
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROCKSON LIU
Credential	:	MD
Telephone Number	:	415-858-0905

Provider Enumeration Date	:	01/13/2022
Last Update Date	:	01/13/2022

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