Provider Demographics
NPI:1295934792
Name:PAUL TC LIU MD, INC
Entity type:Organization
Organization Name:PAUL TC LIU MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:TC
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-796-0821
Mailing Address - Street 1:2233 HUNTINGTON DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2655
Mailing Address - Country:US
Mailing Address - Phone:626-796-0821
Mailing Address - Fax:626-796-0619
Practice Address - Street 1:2233 HUNTINGTON DR
Practice Address - Street 2:SUITE 10
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2655
Practice Address - Country:US
Practice Address - Phone:626-796-0821
Practice Address - Fax:626-796-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67740174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G677400Medicaid