Healthcare Provider Details

I. General information

NPI: 1154137487
Provider Name (Legal Business Name): SEAN LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 S ALHAMBRA AVE
MONTEREY PARK CA
91755-3405
US

IV. Provider business mailing address

531 S ALHAMBRA AVE
MONTEREY PARK CA
91755-3405
US

V. Phone/Fax

Practice location:
  • Phone: 808-999-0288
  • Fax:
Mailing address:
  • Phone: 808-999-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number318663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: