Provider Demographics
NPI:1194739797
Name:LIU, JOHN K (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:LIU
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 1:1318 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-1935
Mailing Address - Country:US
Mailing Address - Phone:323-584-9525
Mailing Address - Fax:323-583-6000
Practice Address - Street 1:1318 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1935
Practice Address - Country:US
Practice Address - Phone:323-584-9525
Practice Address - Fax:323-583-6000
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA65778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A657780Medicaid
CAG75745Medicare UPIN
CAA65778Medicare ID - Type UnspecifiedMEDICARE