Healthcare Provider Details

I. General information

NPI: 1164299905
Provider Name (Legal Business Name): LINDA LIU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30870 RUSSELL RANCH RD STE 330
WESTLAKE VILLAGE CA
91362-7372
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-7015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: