Healthcare Provider Details

I. General information

NPI: 1063945962
Provider Name (Legal Business Name): VIRGINIA Y LIEU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19842 LAKE CHABOT RD
CASTRO VALLEY CA
94546-4002
US

IV. Provider business mailing address

19842 LAKE CHABOT RD
CASTRO VALLEY CA
94546-4002
US

V. Phone/Fax

Practice location:
  • Phone: 510-750-1967
  • Fax: 844-718-0067
Mailing address:
  • Phone: 510-750-1967
  • Fax: 844-718-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA158873
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberA158873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: