1427387869 NPI number — JONATHAN C. LIU MD INC

Table of content: (NPI 1427387869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427387869 NPI number — JONATHAN C. LIU MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONATHAN C. LIU MD INC
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:
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:
1427387869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7507
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93290-7507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-731-2009
Provider Business Mailing Address Fax Number:
559-623-9756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
518 N COURT ST
Provider Second Line Business Practice Location Address:
# B
Provider Business Practice Location Address City Name:
VISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93291-4913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-731-2009
Provider Business Practice Location Address Fax Number:
559-623-9756
Provider Enumeration Date:
12/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LIU
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
559-731-2036

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X , with the licence number:  A97174 , 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: A97174 . This is a "CALIFOORNIA MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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