Provider Demographics
NPI:1891174991
Name:PETERSON, SHIAN LIU (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIAN
Middle Name:LIU
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHIAN
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:NMRTC 29 PALMS
Mailing Address - Street 2:1145 STURGIS ROAD
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92278-8275
Mailing Address - Country:US
Mailing Address - Phone:760-830-2070
Mailing Address - Fax:
Practice Address - Street 1:1145 STURGIS ROAD
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278
Practice Address - Country:US
Practice Address - Phone:619-744-5332
Practice Address - Fax:619-532-8467
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA184167207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN