Healthcare Provider Details

I. General information

NPI: 1821529769
Provider Name (Legal Business Name): RUIKANG LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KONG KONG LIU MD

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4256 HACIENDA DR STE 100
PLEASANTON CA
94588-8595
US

IV. Provider business mailing address

4256 HACIENDA DR STE 100
PLEASANTON CA
94588-8595
US

V. Phone/Fax

Practice location:
  • Phone: 925-263-0313
  • Fax:
Mailing address:
  • Phone: 925-263-0313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number333597
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberA202112
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number333597
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number333597
License Number StateLA
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA202112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: