Provider Demographics
NPI:1184676991
Name:ANDREW T LIU M D AND DOROTHY A SHOUP M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ANDREW T LIU M D AND DOROTHY A SHOUP M D A PROFESSIONAL CORPORATION
Other - Org Name:WOMEN'S CARE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-366-5594
Mailing Address - Street 1:2900 WHIPPLE AVE
Mailing Address - Street 2:#135
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2843
Mailing Address - Country:US
Mailing Address - Phone:650-366-5594
Mailing Address - Fax:650-366-6352
Practice Address - Street 1:2900 WHIPPLE AVE
Practice Address - Street 2:#135
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2843
Practice Address - Country:US
Practice Address - Phone:650-366-5594
Practice Address - Fax:650-366-6352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG633320174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABL564Medicare PIN
CAZZZ23195ZMedicare ID - Type Unspecified