Healthcare Provider Details

I. General information

NPI: 1144647660
Provider Name (Legal Business Name): DAVID HENRY LIU PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVID CALLON LIU

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MOWRY AVE
FREMONT CA
94538-1716
US

IV. Provider business mailing address

2000 MOWRY AVE
FREMONT CA
94538-1716
US

V. Phone/Fax

Practice location:
  • Phone: 510-818-7200
  • Fax: 508-185-8710
Mailing address:
  • Phone: 510-818-7210
  • Fax: 510-818-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberPA51475
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number51475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: