Basic Information
| Provider Information | |||||||||
| NPI: | 1326281064 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JUSTIN LIU MD PROFESSIONAL MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1839 YGNACIO VALLEY RD # 418 | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258204230 | ||||||||
| FaxNumber: | 9258207996 | ||||||||
| Practice Location | |||||||||
| Address1: | JOHN MUIR HOSPITAL-DEPT OF PHYSICAL MED/ REHAB | ||||||||
| Address2: | 1601 YGNACIO VALLEY ROAD | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258204230 | ||||||||
| FaxNumber: | 9258207996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2009 | ||||||||
| LastUpdateDate: | 11/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | LIU | ||||||||
| AuthorizedOfficialFirstName: | JUSTIN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9258204230 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | A76636 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.