Healthcare Provider Details

I. General information

NPI: 1629274782
Provider Name (Legal Business Name): MINGHUI LIU MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W ACACIA ST STE 1
STOCKTON CA
95203-2400
US

IV. Provider business mailing address

530 W ACACIA ST STE 1
STOCKTON CA
95203-2400
US

V. Phone/Fax

Practice location:
  • Phone: 209-242-7098
  • Fax:
Mailing address:
  • Phone: 209-242-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA107140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: