Provider Demographics
NPI:1417143991
Name:LIU, ANNA C (DO)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:C
Last Name:LIU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 WARNER AVE
Mailing Address - Street 2:SUITE 358
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7506
Mailing Address - Country:US
Mailing Address - Phone:714-966-1500
Mailing Address - Fax:714-966-2300
Practice Address - Street 1:11100 WARNER AVE
Practice Address - Street 2:SUITE 358
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7506
Practice Address - Country:US
Practice Address - Phone:714-966-1500
Practice Address - Fax:714-966-2300
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2009-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA130 60 80098OtherCORPORATE NPI #
CAW20A10116AMedicare PIN