Provider Demographics
NPI:1285169508
Name:LIU, SIRAN (AUD)
Entity type:Individual
Prefix:
First Name:SIRAN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OLD NEWPORT BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4234
Mailing Address - Country:US
Mailing Address - Phone:949-642-7935
Mailing Address - Fax:949-642-2950
Practice Address - Street 1:4647 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-358-4583
Practice Address - Fax:210-358-2654
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81010231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist