Healthcare Provider Details

I. General information

NPI: 1861492860
Provider Name (Legal Business Name): NORMAN HONTIN LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 GARDEN GROVE BLVD SUITE 401
GARDEN GROVE CA
92843-1901
US

IV. Provider business mailing address

12665 GARDEN GROVE BLVD SUITE 401
GARDEN GROVE CA
92843-1901
US

V. Phone/Fax

Practice location:
  • Phone: 714-534-8373
  • Fax: 714-534-8759
Mailing address:
  • Phone: 714-534-8373
  • Fax: 714-534-8759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA63593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: