Healthcare Provider Details

I. General information

NPI: 1013379882
Provider Name (Legal Business Name): GRACE LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4053 LONE TREE WAY
ANTIOCH CA
94531-6210
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 925-776-7725
  • Fax: 510-506-7728
Mailing address:
  • Phone: 925-776-7725
  • Fax: 510-506-7728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA161216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: