Provider Demographics
NPI:1114949419
Name:LIU, JOHN SIC-YIU
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SIC-YIU
Last Name:LIU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 CASTRO VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3550 CASTRO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4402
Practice Address - Country:US
Practice Address - Phone:510-581-1680
Practice Address - Fax:510-581-5070
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6498T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0064980Medicaid
P00036039OtherMEDICARE R/R
P00036039OtherMEDICARE R/R
CASD0064980Medicaid