=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124104369
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWARD Y LIU MD A PROF CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2006
-----------------------------------------------------
Last Update Date | 09/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 N CRESCENT DR SUITE 100
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210-4860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-855-0711
-----------------------------------------------------
Fax | 310-652-2688
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 N CRESCENT DR SUITE 100
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210-4860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-855-0711
-----------------------------------------------------
Fax | 310-652-2688
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | EDWARD Y LIU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-855-0711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | G22954
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------