Healthcare Provider Details

I. General information

NPI: 1275858292
Provider Name (Legal Business Name): STEPHEN LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 E LA PALMA AVE MOB1 3RD FLOOR PULMONARY CLINIC
ANAHEIM CA
92806-2020
US

IV. Provider business mailing address

3460 E LA PALMA AVE MOB1 3RD FLOOR PULMONARY CLINIC
ANAHEIM CA
92806-2020
US

V. Phone/Fax

Practice location:
  • Phone: 424-261-9388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA111234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: