Healthcare Provider Details

I. General information

NPI: 1619946753
Provider Name (Legal Business Name): LI LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7887 N CEDAR AVE
FRESNO CA
93720-2685
US

IV. Provider business mailing address

PO BOX 756
DANVILLE CA
94526-0756
US

V. Phone/Fax

Practice location:
  • Phone: 559-437-1000
  • Fax: 559-437-3870
Mailing address:
  • Phone: 877-866-0914
  • Fax: 916-303-8568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA79806
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: