Healthcare Provider Details

I. General information

NPI: 1699302851
Provider Name (Legal Business Name): YANG LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 INTERNATIONAL CIR FL 1
SAN JOSE CA
95119-1130
US

IV. Provider business mailing address

276 INTERNATIONAL CIR
SAN JOSE CA
95119-1130
US

V. Phone/Fax

Practice location:
  • Phone: 408-362-4740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA196986
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0070998
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: