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General NPI Number Information
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NPI Number | 1164471918
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Entity Type | Individual
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Provider Name | FU-TONG LIU MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 10/27/2024
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Provider Practice Location Address
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Address Line | 1450 SAN PABLO ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-5331
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Country | US
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Telephone | 323-442-0084
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31309
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City | LOS ANGELES
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State | CA
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Zip | 90031-0309
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Country | US
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Telephone | 626-457-6601
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G70628
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License Number State | CA
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