Healthcare Provider Details

I. General information

NPI: 1427624576
Provider Name (Legal Business Name): SHUYAN LIU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2021
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W ROUTE 66 STE 302
GLENDORA CA
91740-6252
US

IV. Provider business mailing address

130 W ROUTE 66 STE 302
GLENDORA CA
91740-6252
US

V. Phone/Fax

Practice location:
  • Phone: 626-283-3649
  • Fax:
Mailing address:
  • Phone: 626-914-1534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: