Healthcare Provider Details

I. General information

NPI: 1972517167
Provider Name (Legal Business Name): GENE C LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST SUITE 625E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

8631 W 3RD ST SUITE 625E
LOS ANGELES CA
90048-5901
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-6420
  • Fax: 310-659-8696
Mailing address:
  • Phone: 310-657-6420
  • Fax: 310-659-8696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA90107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: