Provider Demographics
NPI:1518977735
Name:LIEU, BINH CAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BINH
Middle Name:CAM
Last Name:LIEU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:760-901-5010
Mailing Address - Fax:760-433-1263
Practice Address - Street 1:4318 MISSION AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-6541
Practice Address - Country:US
Practice Address - Phone:760-901-5010
Practice Address - Fax:760-433-1263
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A754020Medicaid
CA00A754020Medicaid
CAWA75402AMedicare ID - Type Unspecified