Healthcare Provider Details

I. General information

NPI: 1417042524
Provider Name (Legal Business Name): LIU & WANG MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 S GARFIELD AVE #201
ALHAMBRA CA
91801-4713
US

IV. Provider business mailing address

1118 S GARFIELD AVE #201
ALHAMBRA CA
91801-4713
US

V. Phone/Fax

Practice location:
  • Phone: 626-281-0090
  • Fax: 626-281-0261
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA61726
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA61785
License Number StateCA

VIII. Authorized Official

Name: MARY WANG
Title or Position: MD MANAGER
Credential:
Phone: 626-964-1170