Provider Demographics
NPI:1114098415
Name:LIU, LEEWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LEEWEN
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19040 COX AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6601
Mailing Address - Country:US
Mailing Address - Phone:408-973-8861
Mailing Address - Fax:408-973-8858
Practice Address - Street 1:19040 COX AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6601
Practice Address - Country:US
Practice Address - Phone:408-973-8861
Practice Address - Fax:408-973-8858
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG080609174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY06930Medicare UPIN