Provider Demographics
NPI:1629164520
Name:LIU, DENNIS S (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:S
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W DUARTE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9268
Mailing Address - Country:US
Mailing Address - Phone:626-445-7490
Mailing Address - Fax:626-445-7496
Practice Address - Street 1:622 W DUARTE RD STE 103
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9268
Practice Address - Country:US
Practice Address - Phone:626-445-7490
Practice Address - Fax:626-445-7496
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00146025OtherRAILROAD MEDICARE
CA00A721510OtherBLUE SHIELD
CA00A721510OtherBLUE SHIELD
P00146025OtherRAILROAD MEDICARE