Healthcare Provider Details

I. General information

NPI: 1255781274
Provider Name (Legal Business Name): JOHN LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 KESSLER ST STE 203
SHAWNEE MISSION KS
66204-2553
US

IV. Provider business mailing address

7450 KESSLER ST STE 203
SHAWNEE MISSION KS
66204-2553
US

V. Phone/Fax

Practice location:
  • Phone: 913-789-3920
  • Fax:
Mailing address:
  • Phone: 913-789-3920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2016019076
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0444749
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: