Healthcare Provider Details

I. General information

NPI: 1093900961
Provider Name (Legal Business Name): STEPHEN K LIU MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 COFFEE RD
MODESTO CA
95355-3107
US

IV. Provider business mailing address

1552 COFFEE RD
MODESTO CA
95355-3107
US

V. Phone/Fax

Practice location:
  • Phone: 209-524-2333
  • Fax: 209-524-2142
Mailing address:
  • Phone: 209-524-2333
  • Fax: 209-524-2142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA50939
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA50939
License Number StateCA

VIII. Authorized Official

Name: STEPHEN K LIU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 209-524-2333