Organization Active NPI

Samuel Liu, M.D. Inc.

  • Nephrology Physician
  • Downey, CA
National Provider Identifier
1528211679
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A74056 Issued in CA
Legal business name
SAMUEL LIU, M.D. INC.
Practice address
11480 Brookshire Ave Ste 105
Downey, CA 90241-5020
Phone
(562) 862-0804
Fax
(562) 862-8184
NPI assigned
Nov 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Samuel S Liu, M.D.NPI 1912935628
Title
President/Ceo/Cfo
Phone
(951) 231-0738

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X A74056 CA Primary

Addresses

Primary practice location

11480 Brookshire Ave Ste 105
Downey, CA 90241-5020

Mailing address

1122 Volante Dr
Arcadia, CA 91007-6052
Phone (951) 231-0738

Other practice location 1

210 W Bonita Ave Ste 140
Pomona, CA 91767-1866
Phone (951) 231-0738

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100128000825 CA Part B Supplier - Clinic/Group Practice 0042352007 Receives reassigned benefits from 1 practitioner
Practice locations: Downey, CA; Ontario, CA; Pomona, CA

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

210 W Bonita Ave
Ste 140
Pomona, CA 91767
Phone (909) 622-3800

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1528211679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 VOLANTE DR",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910076052",
            "telephone_number": "951-231-0738",
            "fax_number": "626-698-4515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11480 BROOKSHIRE AVE STE 105",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902415020",
            "telephone_number": "562-862-0804",
            "fax_number": "562-862-8184"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "210 W Bonita Ave Ste 140",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917671866",
            "country_code": "US",
            "telephone_number": "951-231-0738",
            "fax_number": "626-698-4515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAMUEL LIU, M.D. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-01",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "LIU",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT/CEO/CFO",
        "authorized_official_telephone_number": "951-231-0738",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A74056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Downey, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.