Provider Demographics
NPI:1104861657
Name:DAVID KW LIEU
Entity Type:Organization
Organization Name:DAVID KW LIEU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KEN WAH
Authorized Official - Last Name:LIEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-281-7800
Mailing Address - Street 1:320 S GARFIELD AVE
Mailing Address - Street 2:# 278
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3886
Mailing Address - Country:US
Mailing Address - Phone:626-281-7800
Mailing Address - Fax:626-281-7802
Practice Address - Street 1:320 S GARFIELD AVE
Practice Address - Street 2:# 278
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3886
Practice Address - Country:US
Practice Address - Phone:626-281-7800
Practice Address - Fax:626-281-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 315077291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACLF 315077OtherLAB ID NUMBER
CALAB71449FMedicaid
05D0671449OtherCLIA
05D0671449OtherCLIA