Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 132323 | NY |
NPI | 1245394105 |
---|---|
Provider Name | Kang Liu |
First Address | Brooklyn, NY 11231-3659 |
Second Address | Brooklyn, NY 11231-3659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 02/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CO4535 | (02) | NY |