MEDICARE: DR. FU-TONG LIU MD, PHD

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
1	207N00000X	Dermatology Physician	G70628	CA

General Provider Information

NPI Number	:	1164471918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FU-TONG LIU MD, PHD

Provider Business Mailing Address
First Line	:	PO BOX 31309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-0309
Country	:	US
Telephone Number	:	626-457-6601
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 SAN PABLO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5331
Country	:	US
Telephone Number	:	323-442-0084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	10/27/2024

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