Provider Demographics
NPI:1720262801
Name:LIU, TIMOTHY C (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:C
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHEUNG KAY
Other - Middle Name:TIMOTHY
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11622 EL CAMINO REAL STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2051
Mailing Address - Country:US
Mailing Address - Phone:858-264-6463
Mailing Address - Fax:844-834-5633
Practice Address - Street 1:11622 EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2051
Practice Address - Country:US
Practice Address - Phone:858-264-6463
Practice Address - Fax:844-834-5633
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1055352084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry