1326281064 NPI number — JUSTIN LIU MD PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1326281064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326281064 NPI number — JUSTIN LIU MD PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUSTIN LIU MD PROFESSIONAL MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
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NPI Number Information

NPI Number:
1326281064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1839 YGNACIO VALLEY RD # 418
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-3214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-820-4230
Provider Business Mailing Address Fax Number:
925-820-7996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JOHN MUIR HOSPITAL-DEPT OF PHYSICAL MED/ REHAB
Provider Second Line Business Practice Location Address:
1601 YGNACIO VALLEY ROAD
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-820-4230
Provider Business Practice Location Address Fax Number:
925-820-7996
Provider Enumeration Date:
04/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LIU
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
925-820-4230

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  A76636 , 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)





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