Healthcare Provider Details

I. General information

NPI: 1720262801
Provider Name (Legal Business Name): TIMOTHY C LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHEUNG KAY TIMOTHY LIU M.D.

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11622 EL CAMINO REAL STE 100
SAN DIEGO CA
92130-2051
US

IV. Provider business mailing address

11622 EL CAMINO REAL STE 100
SAN DIEGO CA
92130-2051
US

V. Phone/Fax

Practice location:
  • Phone: 858-264-6463
  • Fax: 844-834-5633
Mailing address:
  • Phone: 858-264-6463
  • Fax: 844-834-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA105535
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA105535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: