Healthcare Provider Details

I. General information

NPI: 1780200865
Provider Name (Legal Business Name): KUANG CHUEN LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PING LIU M.D.

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637
US

IV. Provider business mailing address

2300 S MICHIGAN AVENUE APARTMENT 711
CHICAGO IL
60616
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1000
  • Fax:
Mailing address:
  • Phone: 786-369-6947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.076780
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.164826
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: