Healthcare Provider Details

I. General information

NPI: 1699087213
Provider Name (Legal Business Name): ANNIE LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 COLUMBUS AVE
NEW YORK NY
10024-1459
US

IV. Provider business mailing address

1000 W CARSON ST # 3
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 800-750-8616
  • Fax: 845-362-8474
Mailing address:
  • Phone: 310-222-3886
  • Fax: 310-782-8148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number308223
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: