Provider Demographics
NPI:1932102332
Name:LIU, JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
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 1:1484 POLLARD RD # 492
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1031
Mailing Address - Country:US
Mailing Address - Phone:408-866-4030
Mailing Address - Fax:408-871-7491
Practice Address - Street 1:355 DARDANELLI LANE
Practice Address - Street 2:EL CAMINO HOSPITAL INPATIENT REHABILITATION CENTER
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:408-866-4030
Practice Address - Fax:408-871-7491
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A766360208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
I15420Medicare UPIN
CA00A766362Medicare PIN