Provider Demographics
NPI:1780698795
Name:LIU, ROSE W (MD)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:W
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7228 SHANNON PARK CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5023
Mailing Address - Country:US
Mailing Address - Phone:650-872-1451
Mailing Address - Fax:
Practice Address - Street 1:7228 SHANNON PARK CT
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5023
Practice Address - Country:US
Practice Address - Phone:650-872-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000456832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8454779Medicaid
ID1930087Medicare PIN
WAAB39860Medicare ID - Type Unspecified
OR114571Medicare ID - Type Unspecified