Healthcare Provider Details

I. General information

NPI: 1285619825
Provider Name (Legal Business Name): TERRENCE EDWARD LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15944 LOS SERRANOS COUNTRY CLUB DR SUITE 220
CHINO HILLS CA
91709-3993
US

IV. Provider business mailing address

15944 LOS SERRANOS COUNTRY CLUB DR SUITE 220
CHINO HILLS CA
91709-3993
US

V. Phone/Fax

Practice location:
  • Phone: 909-393-6202
  • Fax: 909-393-6204
Mailing address:
  • Phone: 909-393-6202
  • Fax: 909-363-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA00067388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: