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General NPI Number Information
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NPI Number | 1457670226
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA BONE AND JOINT CLINIC INC
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 16008 KAMANA RD SUITE 100
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City | APPLE VALLEY
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State | CA
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Zip | 92307-1376
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Country | US
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Telephone | 760-956-5200
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Fax | 760-669-0793
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Provider Business Mailing Address
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Address Line | 12277 APPLE VALLEY RD #288
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City | APPLE VALLEY
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State | CA
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Zip | 92308-1701
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Country | US
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Telephone | 760-956-5200
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Fax | 760-669-0793
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Authorized Official
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Title or Position | PRESIDENT
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Name | TZU-SHANG THOMAS LIU
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Credential | MD, PHD
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Telephone | 760-956-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A112382
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License Number State | CA
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