Healthcare Provider Details

I. General information

NPI: 1861765901
Provider Name (Legal Business Name): VICTOR LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 EL CAMINO REAL SUITE 200
BURLINGAME CA
94010-3224
US

IV. Provider business mailing address

1720 EL CAMINO REAL SUITE 200
BURLINGAME CA
94010-3224
US

V. Phone/Fax

Practice location:
  • Phone: 650-697-8888
  • Fax: 650-697-9208
Mailing address:
  • Phone: 650-697-8888
  • Fax: 650-697-9208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG32726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: