Provider Demographics
NPI:1619996980
Name:LIKER, HARLEY RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:HARLEY
Middle Name:RUSSELL
Last Name:LIKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9675 BRIGHTON WAY
Mailing Address - Street 2:350
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5100
Mailing Address - Country:US
Mailing Address - Phone:310-860-1550
Mailing Address - Fax:310-205-5595
Practice Address - Street 1:9675 BRIGHTON WAY
Practice Address - Street 2:350
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5100
Practice Address - Country:US
Practice Address - Phone:310-860-1550
Practice Address - Fax:310-205-5595
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G790840OtherMEDICAL PPIN #
CAWG79084AMedicare ID - Type UnspecifiedPPIN #
CA00G790840OtherMEDICAL PPIN #