Provider Demographics
NPI:1881734465
Name:LIU, JOHN T (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 241699
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-9499
Mailing Address - Country:US
Mailing Address - Phone:213-484-8474
Mailing Address - Fax:213-484-9054
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:STE 914
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-484-8474
Practice Address - Fax:213-484-9054
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA69994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABL6590598OtherDEA
CABL6590598OtherDEA
CAH28962Medicare UPIN