Provider Demographics
NPI:1780066472
Name:LIU, JIE (MD)
Entity type:Individual
Prefix:DR
First Name:JIE
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 WASHINGTON ST # 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2110
Mailing Address - Country:US
Mailing Address - Phone:619-438-4348
Mailing Address - Fax:
Practice Address - Street 1:302 WASHINGTON ST # 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2110
Practice Address - Country:US
Practice Address - Phone:619-438-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA147758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036166709OtherSTATE LICENSE
NY323476-01OtherSTATE LICENSE
MIEMC0003850OtherSTATE LICENSE
WAMD61368889OtherSTATE LICENSE
FLME164158OtherSTATE LICENSE
COCDR.03117OtherSTATE LICENSE
TXU6396OtherSTATE LICENSE
WI3415-320OtherSTATE LICENSE
AZ71292OtherSTATE LICENSE
NJ25MA11856500OtherSTATE LICENSE
AL47156OtherSTATE LICENSE