Healthcare Provider Details

I. General information

NPI: 1578314340
Provider Name (Legal Business Name): STANLEY LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

IV. Provider business mailing address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7523
  • Fax:
Mailing address:
  • Phone: 916-734-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1578314340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: