Healthcare Provider Details

I. General information

NPI: 1295830768
Provider Name (Legal Business Name): RUTH Y LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N LINCOLN ST #G
DIXON CA
95620-3258
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD SUITE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 707-678-1623
  • Fax: 707-678-0258
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG57017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: