Healthcare Provider Details

I. General information

NPI: 1912935628
Provider Name (Legal Business Name): SAMUEL S LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11480 BROOKSHIRE AVE STE 105
DOWNEY CA
90241-5020
US

IV. Provider business mailing address

1122 VOLANTE DR
ARCADIA CA
91007-6052
US

V. Phone/Fax

Practice location:
  • Phone: 562-862-8184
  • Fax: 562-862-8184
Mailing address:
  • Phone: 951-231-0738
  • Fax: 626-337-6625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA74056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: