Healthcare Provider Details

I. General information

NPI: 1538137013
Provider Name (Legal Business Name): JOEY LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E JANSS RD,
THOUSAND OAKS CA
91360
US

IV. Provider business mailing address

620 E JANSS RD,
THOUSAND OAKS CA
91360
US

V. Phone/Fax

Practice location:
  • Phone: 805-495-6866
  • Fax: 805-495-8085
Mailing address:
  • Phone: 805-495-6866
  • Fax: 805-495-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA064109
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA64109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: