Provider Demographics
NPI:1205977345
Name:LIU, TERRENCE H (MD)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:H
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 1:5528 PACHECO BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:PACHECO
Mailing Address - State:CA
Mailing Address - Zip Code:94553-5126
Mailing Address - Country:US
Mailing Address - Phone:925-363-8170
Mailing Address - Fax:
Practice Address - Street 1:1411 E 31ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1018
Practice Address - Country:US
Practice Address - Phone:510-437-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50912208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C509120Medicaid
G34245Medicare UPIN
CA00C509120Medicare ID - Type Unspecified