Individual
JACK LIU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10800 MAGNOLIA AVE, RIVERSIDE, CA 92505-3043
(951) 353-4996
Mailing address
16009 LEGACY RD, UNIT 414, TUSTIN, CA 92782-2800
(951) 353-4996
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
A129495
CA
Other
Enumeration date
08/25/2008
Last updated
12/16/2021
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