Healthcare Provider Details

I. General information

NPI: 1790187920
Provider Name (Legal Business Name): JING LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 UNION AVE UNIT 12
BAKERSFIELD CA
93305-2432
US

IV. Provider business mailing address

3901 UNION AVE UNIT 12
BAKERSFIELD CA
93305-2432
US

V. Phone/Fax

Practice location:
  • Phone: 925-699-1710
  • Fax:
Mailing address:
  • Phone: 925-699-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number206676914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: