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General NPI Number Information
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NPI Number | 1093900961
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Entity Type | Organization
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Legal Business Name | STEPHEN K LIU MD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 1552 COFFEE RD
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City | MODESTO
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State | CA
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Zip | 95355-3107
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Country | US
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Telephone | 209-524-2333
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Fax | 209-524-2142
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Provider Business Mailing Address
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Address Line | 1552 COFFEE RD
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City | MODESTO
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State | CA
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Zip | 95355-3107
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Country | US
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Telephone | 209-524-2333
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Fax | 209-524-2142
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN K LIU
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Credential | M.D.
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Telephone | 209-524-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A50939
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | A50939
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License Number State | CA
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