Provider Demographics
NPI:1497003511
Name:CHIA-LIN CHARLES LIU,D.O.,INC
Entity Type:Organization
Organization Name:CHIA-LIN CHARLES LIU,D.O.,INC
Other - Org Name:CHIA-LIN LIU
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIA
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:8589-270-9270
Mailing Address - Street 1:2185 GARNET AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3603
Mailing Address - Country:US
Mailing Address - Phone:858-270-9270
Mailing Address - Fax:858-270-7168
Practice Address - Street 1:2185 GARNET AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3603
Practice Address - Country:US
Practice Address - Phone:858-270-9270
Practice Address - Fax:858-270-7168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A6900OtherPTAN
CA20A6900OtherPTAN