Provider Demographics
NPI:1326496167
Name:LIU, WILSON (DO)
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 W TEMPLE ST STE 4691
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-7336
Mailing Address - Country:US
Mailing Address - Phone:213-238-5887
Mailing Address - Fax:
Practice Address - Street 1:1711 W TEMPLE ST STE 4691
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-7336
Practice Address - Country:US
Practice Address - Phone:213-238-5887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine