Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | A061446 | CA |
NPI | 1477564128 |
---|---|
Provider Name | Dr. Grace S Liu |
First Address | Newport Beach, CA 92660-3058 |
Second Address | Newport Beach, CA 92660-3058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 12/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W16839 | MEDICARE GROUP NUMBER (01) | CA |
Y01048 | (02) | CA |