Healthcare Provider Details

I. General information

NPI: 1699583765
Provider Name (Legal Business Name): ZITAO LIU, M.D. PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39277 LIBERTY ST
FREMONT CA
94538-1519
US

IV. Provider business mailing address

39277 LIBERTY ST
FREMONT CA
94538-1519
US

V. Phone/Fax

Practice location:
  • Phone: 341-248-8826
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ZITAO LIU
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 341-248-8826