Healthcare Provider Details

I. General information

NPI: 1053966200
Provider Name (Legal Business Name): DARRYL LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 MALONE RD
SAN JOSE CA
95125-2639
US

IV. Provider business mailing address

PO BOX 61207
PALO ALTO CA
94306-6207
US

V. Phone/Fax

Practice location:
  • Phone: 408-409-6727
  • Fax:
Mailing address:
  • Phone: 408-409-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW93319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: