Healthcare Provider Details

I. General information

NPI: 1528562964
Provider Name (Legal Business Name): TIFFANY C LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 9TH AVE STE 210
LONGVIEW WA
98632-2465
US

IV. Provider business mailing address

625 9TH AVE STE 210
LONGVIEW WA
98632-2465
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-6548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD61545084
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: