Healthcare Provider Details

I. General information

NPI: 1396277364
Provider Name (Legal Business Name): FRED LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 01/13/2023
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 N EUCLID ST
ANAHEIM CA
92801-1900
US

IV. Provider business mailing address

1188 N EUCLID ST
ANAHEIM CA
92801-1900
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA158767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: