Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 25MA07759500 | NJ |
Y | 207U00000X | Nuclear Medicine Specialist | TP643 | KY |
NPI | 1275558314 |
---|---|
Provider Name | Yiyan Liu |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-1675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 07/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0059382 | (05) | NJ |
I24028 | (02) | |
MEDICARE | K355840 (01) | KY |