Basic Information
| Provider Information | |||||||||
| NPI: | 1912943127 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIU | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | YIU-YUI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2866 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905092866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107920662 | ||||||||
| FaxNumber: | 3107929062 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 N PRAIRIE AVE | ||||||||
| Address2: | |||||||||
| City: | INGLEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 903014501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106737050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | G18898 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00G188980 | 01 | CA | BLUE SHIELD | OTHER | 00G188980 | 05 | CA | MEDICAID |