1710967914 NPI number — DR. MARK YEEJEN LIU DO

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710967914 NPI number — DR. MARK YEEJEN LIU DO

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LIU

Provider First Name:

MARK

Provider Middle Name:

YEEJEN

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

DO

Provider Gender Code:

M

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:

1710967914

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/16/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

7978 POCKET RD APT 154

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:

95831-5726

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

509-730-4720

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

6644 LONETREE BLVD STE 300

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ROCKLIN

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

95765-4432

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

916-721-2977

Provider Business Practice Location Address Fax Number:

916-659-9629

Provider Enumeration Date:

01/23/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  DOS-1207 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: OP1714 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 20A22527 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 7710782 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: OP1714 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 632712-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
• Identifier: 8449845 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
• Identifier: 5389LI . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 22527 . This is a "MEDICAL BOARD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 0000284265 . This is a "HMSA BILLING NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: 20A22527 . This is a "MEDICAL BOARD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: P00338717 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 208083 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".