Healthcare Provider Details

I. General information

NPI: 1518256130
Provider Name (Legal Business Name): TING TING LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 14TH ST
NEW YORK NY
10003-4201
US

IV. Provider business mailing address

1309 RANGETON DR
DIAMOND BAR CA
91789-3824
US

V. Phone/Fax

Practice location:
  • Phone: 212-477-7540
  • Fax:
Mailing address:
  • Phone: 626-922-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number273923-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: