Provider Demographics
NPI:1316978083
Name:LIU, GRACE YINGSHI (MD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:YINGSHI
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W VALLEY BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3256
Mailing Address - Country:US
Mailing Address - Phone:626-308-1696
Mailing Address - Fax:
Practice Address - Street 1:801 W VALLEY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3256
Practice Address - Country:US
Practice Address - Phone:626-308-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48127207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE55957Medicare UPIN
CAA48127Medicare ID - Type Unspecified