Healthcare Provider Details

I. General information

NPI: 1023358611
Provider Name (Legal Business Name): AMY XIAO SONG LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD # 68
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

1634 7TH AVE
HACIENDA HEIGHTS CA
91745-3250
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2122
  • Fax:
Mailing address:
  • Phone: 626-290-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA121184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: