Provider Demographics
NPI:1215194808
Name:LIU, JEROME H (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:H
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:15055 LOS GATOS BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2083
Mailing Address - Country:US
Mailing Address - Phone:408-418-0808
Mailing Address - Fax:
Practice Address - Street 1:15055 LOS GATOS BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2083
Practice Address - Country:US
Practice Address - Phone:408-418-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA64676208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BX206ZMedicare UPIN