Healthcare Provider Details

I. General information

NPI: 1063197051
Provider Name (Legal Business Name): SITONG LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W LA VETA AVE
ORANGE CA
92868-4304
US

IV. Provider business mailing address

1105 E KATELLA AVE UNIT 239
ANAHEIM CA
92805-8695
US

V. Phone/Fax

Practice location:
  • Phone: 714-734-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW024295
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139721
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW136170
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: