Provider Demographics
NPI:1518096270
Name:LIU, MINGHSUN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MINGHSUN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11103 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6914
Mailing Address - Country:US
Mailing Address - Phone:650-224-7359
Mailing Address - Fax:310-697-1999
Practice Address - Street 1:11103 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6914
Practice Address - Country:US
Practice Address - Phone:310-734-8526
Practice Address - Fax:310-734-8470
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85950207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ58473OtherARIZONA MEDICAL BOARD-STATE LICENSE
FLME144496OtherFLORIDA DEPARTMENT OF HEALTH
UT11302963-1205OtherUT BOARD
FL117649400Medicaid
NV250024336Medicaid
AZ604186Medicaid
CAA85950OtherSTATE LICENSE
CA1518096270Medicaid
HIMD-20352OtherHAWAII STATE LICENSE
NV19566OtherNEVADA STATE BOARD OF MEDICAL EXAMINERS
NY301044OtherNY STATE LICENSE