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NPI Code Detail

MEDICARE: STEPHEN K LIU MD PROFESSIONAL CORPORATION

MEDICARE: STEPHEN K LIU MD PROFESSIONAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianA50939CA
22085R0204XVascular & Interventional Radiology PhysicianA50939CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11306889860OTHERCANPI FOR STEPHEN K LIU MD

General Provider Information

NPI Number : 1093900961
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEPHEN K LIU MD PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : 1552 COFFEE RD
Second Line :
City : MODESTO
State : CA
Zip : 95355-3107
Country : US
Telephone Number : 209-524-2333
Fax Number : 209-524-2142
Provider Business Practice Location Address
First Line : 1552 COFFEE RD
Second Line :
City : MODESTO
State : CA
Zip : 95355-3107
Country : US
Telephone Number : 209-524-2333
Fax Number : 209-524-2142
Authorized Official
Title or Position : PRESIDENT
Name : STEPHEN K LIU
Credential : M.D.
Telephone Number : 209-524-2333
Provider Enumeration Date : 09/13/2007
Last Update Date : 02/27/2008

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