Healthcare Provider Details

I. General information

NPI: 1013654664
Provider Name (Legal Business Name): MATTHEW LI-AN AU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 S CRISMON RD
MESA AZ
85209-6216
US

IV. Provider business mailing address

150 BERGEN ST RM I-248
NEWARK NJ
07103-2496
US

V. Phone/Fax

Practice location:
  • Phone: 480-610-7100
  • Fax:
Mailing address:
  • Phone: 973-972-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number74247
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: