Provider Demographics
NPI:1912935628
Name:LIU, SAMUEL S (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:S
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 VOLANTE DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6052
Mailing Address - Country:US
Mailing Address - Phone:951-231-0738
Mailing Address - Fax:626-337-6625
Practice Address - Street 1:11480 BROOKSHIRE AVE STE 302
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5024
Practice Address - Country:US
Practice Address - Phone:562-862-8184
Practice Address - Fax:562-862-8184
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74056207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH74095Medicare UPIN