Provider Demographics
NPI:1275109787
Name:LIU, KEVIN EDWARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:EDWARD
Last Name:LIU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3456 ASHBOURNE PL
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-5181
Mailing Address - Country:US
Mailing Address - Phone:626-518-2143
Mailing Address - Fax:
Practice Address - Street 1:10441 LAKEWOOD BLVD STE E
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2744
Practice Address - Country:US
Practice Address - Phone:626-518-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA59605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant