Provider Demographics
NPI:1912966680
Name:LIEU, DAVID KEN WAH (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KEN WAH
Last Name:LIEU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 S GARFIELD AVE
Mailing Address - Street 2:# 278
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3886
Mailing Address - Country:US
Mailing Address - Phone:626-288-7800
Mailing Address - Fax:626-288-7802
Practice Address - Street 1:320 S GARFIELD AVE
Practice Address - Street 2:# 278
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3886
Practice Address - Country:US
Practice Address - Phone:626-281-7800
Practice Address - Fax:626-281-7802
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG42121207ZC0500X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G421211Medicaid
CAG42121Medicare ID - Type Unspecified
CAB57047Medicare UPIN