Provider Demographics
NPI:1376513846
Name:LIEU, KO-MYONG (MD)
Entity Type:Individual
Prefix:
First Name:KO-MYONG
Middle Name:
Last Name:LIEU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 POST ST
Mailing Address - Street 2:STE 202
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3600
Mailing Address - Country:US
Mailing Address - Phone:415-346-2777
Mailing Address - Fax:415-346-1116
Practice Address - Street 1:1610 POST ST
Practice Address - Street 2:STE 202
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3600
Practice Address - Country:US
Practice Address - Phone:415-346-2777
Practice Address - Fax:415-346-1116
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA321732084N0400X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
A26719Medicare UPIN