MEDICARE: JIANDONG LIU MD

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	207R00000X	Internal Medicine Physician	45913	WI
2	207R00000X	Internal Medicine Physician	A96949	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649238130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIANDONG LIU MD

Provider Business Mailing Address
First Line	:	2902 E VIRGINIA AVE
Second Line	:	#12
City	:	WEST COVINA
State	:	CA
Zip	:	91791-2159
Country	:	US
Telephone Number	:	626-676-0172
Fax Number	:

Provider Business Practice Location Address
First Line	:	2902 E VIRGINIA AVE
Second Line	:	#12
City	:	WEST COVINA
State	:	CA
Zip	:	91791-2159
Country	:	US
Telephone Number	:	626-676-0172
Fax Number	:

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	11/29/2021

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Directions to “ JIANDONG LIU MD” Practice Location

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