Healthcare Provider Details

I. General information

NPI: 1336259274
Provider Name (Legal Business Name): LOUIS HSI-TIEN LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19185 SW 90TH AVE
TUALATIN OR
97062-7558
US

IV. Provider business mailing address

2727 SW PATTON CT
PORTLAND OR
97201-1642
US

V. Phone/Fax

Practice location:
  • Phone: 503-885-7300
  • Fax:
Mailing address:
  • Phone: 503-233-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD22905
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: