Provider Demographics
NPI:1326281064
Name:JUSTIN LIU MD PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JUSTIN LIU MD PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-820-4230
Mailing Address - Street 1:1839 YGNACIO VALLEY RD # 418
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3214
Mailing Address - Country:US
Mailing Address - Phone:925-820-4230
Mailing Address - Fax:925-820-7996
Practice Address - Street 1:JOHN MUIR HOSPITAL-DEPT OF PHYSICAL MED/ REHAB
Practice Address - Street 2:1601 YGNACIO VALLEY ROAD
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-820-4230
Practice Address - Fax:925-820-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76636208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty