Healthcare Provider Details

I. General information

NPI: 1518980663
Provider Name (Legal Business Name): ANTONIO K. LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S RAYMOND AVE
ALHAMBRA CA
91801-3166
US

IV. Provider business mailing address

150 S RAYMOND AVE
ALHAMBRA CA
91801-3166
US

V. Phone/Fax

Practice location:
  • Phone: 626-300-0008
  • Fax: 626-300-0191
Mailing address:
  • Phone: 626-300-0008
  • Fax: 626-300-0191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number30171
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberT8882
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2022038336
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA062246
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME159509
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number66692
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberTHMD00033
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: