Provider Demographics
NPI:1962947184
Name:LIU, SAMANTHA (MD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:TRAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:212 9TH ST STE 401
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4428
Mailing Address - Country:US
Mailing Address - Phone:415-686-9128
Mailing Address - Fax:510-879-7406
Practice Address - Street 1:212 9TH ST STE 401
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4428
Practice Address - Country:US
Practice Address - Phone:415-686-9128
Practice Address - Fax:510-879-7406
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG778842084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG77884OtherMEDICAL LICENSE
CAB4028267OtherDMV DRIVERS LICENSE
CAB4028267OtherDMV DRIVERS LICENSE