Provider Demographics
NPI:1972517167
Name:LIU, GENE C (MD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:C
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 625E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-657-6420
Mailing Address - Fax:310-659-8696
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 625E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-657-6420
Practice Address - Fax:310-659-8696
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA90107207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22653Medicare UPIN