Healthcare Provider Details

I. General information

NPI: 1710967914
Provider Name (Legal Business Name): MARK YEEJEN LIU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6644 LONETREE BLVD STE 300
ROCKLIN CA
95765-4432
US

IV. Provider business mailing address

7978 POCKET RD APT 154
SACRAMENTO CA
95831-5726
US

V. Phone/Fax

Practice location:
  • Phone: 916-721-2977
  • Fax: 916-659-9629
Mailing address:
  • Phone: 509-730-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDOS-1207
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP1714
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A22527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: