Provider Demographics
NPI:1093900961
Name:STEPHEN K LIU MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:STEPHEN K LIU MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-524-2333
Mailing Address - Street 1:1552 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3107
Mailing Address - Country:US
Mailing Address - Phone:209-524-2333
Mailing Address - Fax:209-524-2142
Practice Address - Street 1:1552 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3107
Practice Address - Country:US
Practice Address - Phone:209-524-2333
Practice Address - Fax:209-524-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA509392085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306889860OtherNPI FOR STEPHEN K LIU MD
CAZZZ06494ZMedicare PIN
CAG83544Medicare UPIN
CA00A509392Medicare PIN