Healthcare Provider Details

I. General information

NPI: 1710366059
Provider Name (Legal Business Name): YUCHEN LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 07/07/2023
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N TUSTIN AVE STE 400
SANTA ANA CA
92705-3850
US

IV. Provider business mailing address

SUNY AT STONY BROOK 101 NICOLLS RD DEPARTMENT OF ANESTHESIA
STONY BROOK NY
11794-8480
US

V. Phone/Fax

Practice location:
  • Phone: 146-195-3837
  • Fax:
Mailing address:
  • Phone: 631-444-2975
  • Fax: 631-444-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA159502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: