Healthcare Provider Details

I. General information

NPI: 1316620537
Provider Name (Legal Business Name): DANIEL LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11420 WARNER AVE
FOUNTAIN VALLEY CA
92708-2529
US

IV. Provider business mailing address

4901 RAIN TREE LN
IRVINE CA
92612-2818
US

V. Phone/Fax

Practice location:
  • Phone: 657-204-2959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number304485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: