Provider Demographics
NPI:1528191095
Name:LIU, LINDA G (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:G
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:525 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5616
Mailing Address - Country:US
Mailing Address - Phone:619-585-4397
Mailing Address - Fax:619-585-4005
Practice Address - Street 1:525 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5616
Practice Address - Country:US
Practice Address - Phone:619-585-4397
Practice Address - Fax:619-585-4005
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241955207P00000X
CAA 109368207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1528191095Medicaid
CACQ425ZMedicare PIN
CA1528191095Medicaid