Healthcare Provider Details

I. General information

NPI: 1609106459
Provider Name (Legal Business Name): TONY TONGYU LIU D.O., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 W BADILLO ST STE D
COVINA CA
91723-1966
US

IV. Provider business mailing address

233 W BADILLO ST STE D
COVINA CA
91723-1966
US

V. Phone/Fax

Practice location:
  • Phone: 626-655-8286
  • Fax: 866-925-0061
Mailing address:
  • Phone: 626-655-8286
  • Fax: 866-925-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A12147
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A12147
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number20A12147
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number20A12147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: