Healthcare Provider Details

I. General information

NPI: 1932668076
Provider Name (Legal Business Name): LUCY SIQING LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST RM 1011
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

1200 N STATE ST RM 1011
LOS ANGELES CA
90033-1029
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-7053
  • Fax:
Mailing address:
  • Phone: 323-409-7053
  • Fax: 323-226-7927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA179699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: