Healthcare Provider Details

I. General information

NPI: 1275392334
Provider Name (Legal Business Name): KEVIN C LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PARNASSUS AVENUE MU 320 WEST
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

500 PARNASSUS AVE MU 320 WEST
SAN FRANCISCO CA
94143-2203
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-6548
  • Fax:
Mailing address:
  • Phone: 916-832-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: