Healthcare Provider Details

I. General information

NPI: 1477564128
Provider Name (Legal Business Name): GRACE S LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3991 MACARTHUR BLVD SUITE 228
NEWPORT BEACH CA
92660-3058
US

IV. Provider business mailing address

3991 MACARTHUR BLVD SUITE 228
NEWPORT BEACH CA
92660-3058
US

V. Phone/Fax

Practice location:
  • Phone: 949-863-0988
  • Fax: 949-863-0088
Mailing address:
  • Phone: 949-863-0988
  • Fax: 949-863-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA061446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: