Provider Demographics
NPI:1679791909
Name:LIU, DEEDE Y (MD)
Entity type:Individual
Prefix:
First Name:DEEDE
Middle Name:Y
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 1:100 PRINGLE AVE
Mailing Address - Street 2:STE 425
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-7385
Mailing Address - Country:US
Mailing Address - Phone:925-932-3800
Mailing Address - Fax:925-933-3339
Practice Address - Street 1:UNIVERSITY OF KANSAS MED CTR 3901 RAINBOW BLVD
Practice Address - Street 2:MS 2025 DIVISION OF DERMATOLOGY
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC155845207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty