Healthcare Provider Details

I. General information

NPI: 1962195800
Provider Name (Legal Business Name): YI-LING LIU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE LIU DO

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 W HAMMER LN
STOCKTON CA
95209-2839
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 209-957-7050
  • Fax: 209-473-9359
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT022337
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A24668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: