1376543975 NPI number — DR. SHAOXIONG LIU MD

Table of content: DR. SHAOXIONG LIU MD (NPI 1376543975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376543975 NPI number — DR. SHAOXIONG LIU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIU
Provider First Name:
SHAOXIONG
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376543975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4301 X ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95817-2214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-734-2011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 X ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-2214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-2011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  216520 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: C54050 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1376543975 . This is a "BMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 92083 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2101874 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 468491 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1376543975 . This is a "NHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203722881 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: J28396 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9618716 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 96939902 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA63598 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".




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