Provider Demographics
NPI:1710967914
Name:LIU, MARK YEEJEN (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:YEEJEN
Last Name:LIU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:7978 POCKET RD APT 154
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5726
Mailing Address - Country:US
Mailing Address - Phone:509-730-4720
Mailing Address - Fax:
Practice Address - Street 1:6644 LONETREE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4432
Practice Address - Country:US
Practice Address - Phone:916-721-2977
Practice Address - Fax:916-659-9629
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIDOS-1207207Q00000X
WAOP1714207Q00000X
CA20A22527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7710782OtherAETNA
WAOP1714OtherSTATE MEDICAL LICENSE
HI632712-01Medicaid
WA8449845Medicaid
WA5389LIOtherREGENCE BLUE SHIELD
CA22527OtherMEDICAL BOARD
HI0000284265OtherHMSA BILLING NUMBER
CA20A22527OtherMEDICAL BOARD
P00338717OtherRAILROAD MEDICARE
WA208083OtherLABOR & INDUSTRIES
P00338717OtherRAILROAD MEDICARE
HIBT171ZMedicare PIN
7710782OtherAETNA
WA5389LIOtherREGENCE BLUE SHIELD