Healthcare Provider Details

I. General information

NPI: 1194739797
Provider Name (Legal Business Name): JOHN K LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7143 SEVILLE AVE
HUNTINGTON PARK CA
90255-4905
US

IV. Provider business mailing address

7143 SEVILLE AVE
HUNTINGTON PARK CA
90255-4905
US

V. Phone/Fax

Practice location:
  • Phone: 323-584-9525
  • Fax: 323-583-6000
Mailing address:
  • Phone: 323-584-9525
  • Fax: 323-583-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA65778
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA65778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: