Provider Demographics
NPI:1720088552
Name:LIU, CHIA-LIN (DO)
Entity Type:Individual
Prefix:
First Name:CHIA-LIN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:CHIA-LIN
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2185 GARNET AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3603
Mailing Address - Country:US
Mailing Address - Phone:858-270-9270
Mailing Address - Fax:858-270-7168
Practice Address - Street 1:2185 GARNET AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3603
Practice Address - Country:US
Practice Address - Phone:858-270-9270
Practice Address - Fax:858-270-7168
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH44668Medicare UPIN