Healthcare Provider Details

I. General information

NPI: 1770895559
Provider Name (Legal Business Name): JOSEPH P. LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N PROSPECT AVE STE 101
REDONDO BEACH CA
90277
US

IV. Provider business mailing address

1160D PITTSFORD VICTOR RD FL 2
PITTSFORD NY
14534-3818
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-3433
  • Fax: 313-577-8600
Mailing address:
  • Phone: 585-218-8005
  • Fax: 585-218-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301096346
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA130982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: