Healthcare Provider Details

I. General information

NPI: 1932631462
Provider Name (Legal Business Name): YINGNA LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W GRANT LINE RD STE 240
TRACY CA
95377-7335
US

IV. Provider business mailing address

365 LENNON LN STE 250
WALNUT CREEK CA
94598-5915
US

V. Phone/Fax

Practice location:
  • Phone: 800-573-8462
  • Fax: 925-623-5090
Mailing address:
  • Phone: 800-573-8462
  • Fax: 925-943-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License NumberA157345
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA157345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: