Healthcare Provider Details

I. General information

NPI: 1376161133
Provider Name (Legal Business Name): YUPENG LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1005 MOANALUA RD SPC 3030
AIEA HI
96701-4735
US

IV. Provider business mailing address

98-1005 MOANALUA RD SPC 3030
AIEA HI
96701-4735
US

V. Phone/Fax

Practice location:
  • Phone: 808-627-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMDR-8004
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: