Healthcare Provider Details

I. General information

NPI: 1821225418
Provider Name (Legal Business Name): PHILIP MUNN LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SOUTH DR STE 11
MOUNTAIN VIEW CA
94040-4209
US

IV. Provider business mailing address

515 SOUTH DR STE 11
MOUNTAIN VIEW CA
94040-4209
US

V. Phone/Fax

Practice location:
  • Phone: 650-961-8923
  • Fax: 650-961-1771
Mailing address:
  • Phone: 650-961-8923
  • Fax: 650-961-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG29814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: