Healthcare Provider Details

I. General information

NPI: 1821529306
Provider Name (Legal Business Name): KEVIN LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W VALLEY BLVD STE 100
SAN GABRIEL CA
91776-5716
US

IV. Provider business mailing address

506 W VALLEY BLVD STE 100
SAN GABRIEL CA
91776-5716
US

V. Phone/Fax

Practice location:
  • Phone: 626-308-3800
  • Fax:
Mailing address:
  • Phone: 626-400-3814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA201631
License Number StateCA
# 2
Primary TaxonomyN
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: