Healthcare Provider Details

I. General information

NPI: 1013227479
Provider Name (Legal Business Name): ANTOINETTE KIM LIEU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FAIRMOUNT AVE
SAN DIEGO CA
92105-1608
US

IV. Provider business mailing address

13336 JIMMY WAY
POWAY CA
92064-1138
US

V. Phone/Fax

Practice location:
  • Phone: 619-564-7013
  • Fax: 855-845-9449
Mailing address:
  • Phone: 408-891-5056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: