MEDICARE: ANNETTE LIU, M.D., INC

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	208000000X	Pediatrics Physician	A56497	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A56497	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1760424493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNETTE LIU, M.D., INC

Provider Business Mailing Address
First Line	:	824 E CARSON ST
Second Line	:	SUITE 202
City	:	CARSON
State	:	CA
Zip	:	90745-2262
Country	:	US
Telephone Number	:	310-233-3209
Fax Number	:	310-233-3211

Provider Business Practice Location Address
First Line	:	824 E CARSON ST
Second Line	:	SUITE 202
City	:	CARSON
State	:	CA
Zip	:	90745-2262
Country	:	US
Telephone Number	:	310-233-3209
Fax Number	:	310-233-3211

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANNETTE LIU
Credential	:	M.D.
Telephone Number	:	310-233-3209

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	08/22/2020

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