Provider Demographics
NPI:1376708040
Name:LIU, SIYUAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SIYUAN
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SUPERIOR AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3676
Mailing Address - Country:US
Mailing Address - Phone:949-759-2222
Mailing Address - Fax:949-759-2021
Practice Address - Street 1:500 SUPERIOR AVE STE 150
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3676
Practice Address - Country:US
Practice Address - Phone:949-759-2222
Practice Address - Fax:949-759-2021
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist