Healthcare Provider Details

I. General information

NPI: 1205977345
Provider Name (Legal Business Name): TERRENCE H LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

5528 PACHECO BLVD STE A
PACHECO CA
94553-5126
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4965
  • Fax:
Mailing address:
  • Phone: 925-363-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC50912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: