Healthcare Provider Details

I. General information

NPI: 1255416236
Provider Name (Legal Business Name): YI YI LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 39TH AVE
SAN MATEO CA
94403-4364
US

IV. Provider business mailing address

739 SAN LUCAS AVE
MOUNTAIN VIEW CA
94043-1914
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-3702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA65470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: