Healthcare Provider Details

I. General information

NPI: 1558528711
Provider Name (Legal Business Name): YI LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 12/20/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUTHRIE SQ FAMILY MEDICINE PROGRAM
SAYRE PA
18840-1625
US

IV. Provider business mailing address

1001 RIVERSIDE AVE
ROSEVILLE CA
95678-5134
US

V. Phone/Fax

Practice location:
  • Phone: 570-882-3335
  • Fax:
Mailing address:
  • Phone: 916-784-4000
  • Fax: 877-738-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT187349
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA106287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: