Provider Demographics
NPI:1518980663
Name:LIU, ANTONIO K (MD)
Entity Type:Individual
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First Name:ANTONIO
Middle Name:K
Last Name:LIU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:150 S RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3166
Mailing Address - Country:US
Mailing Address - Phone:626-300-0008
Mailing Address - Fax:626-300-0191
Practice Address - Street 1:150 S RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3166
Practice Address - Country:US
Practice Address - Phone:626-300-0008
Practice Address - Fax:626-300-0191
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-05-02
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Provider Licenses
StateLicense IDTaxonomies
MS301712084N0400X
TXT88822084N0400X
MO20220383362084N0400X
CAA062246207T00000X
FLME1595092084N0400X
TN666922084N0400X
AZTHMD000332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A622460Medicaid
AZ162215Medicaid
MS000071004Medicaid
TNQ080045Medicaid