Provider Demographics
NPI:1861594681
Name:LIU, WINSON (MD)
Entity type:Individual
Prefix:DR
First Name:WINSON
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 SHERMAN DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4001
Mailing Address - Country:US
Mailing Address - Phone:951-688-3849
Mailing Address - Fax:951-688-8045
Practice Address - Street 1:3838 SHERMAN DR
Practice Address - Street 2:SUITE 10
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4001
Practice Address - Country:US
Practice Address - Phone:951-688-3849
Practice Address - Fax:951-688-8045
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A643290Medicaid
CAH23225Medicare UPIN
CA00A643290Medicaid
GA080195123Medicare ID - Type UnspecifiedRAILROAD MEDICARE