Provider Demographics
NPI:1477564128
Name:LIU, GRACE S (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:S
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3991 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 228
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3058
Mailing Address - Country:US
Mailing Address - Phone:949-863-0988
Mailing Address - Fax:949-863-0088
Practice Address - Street 1:3991 MACARTHUR BLVD
Practice Address - Street 2:SUITE 228
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3058
Practice Address - Country:US
Practice Address - Phone:949-863-0988
Practice Address - Fax:949-863-0088
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-10-12
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Provider Licenses
StateLicense IDTaxonomies
CAA061446207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16839OtherMEDICARE GROUP NUMBER
CAW16839OtherMEDICARE GROUP NUMBER