Healthcare Provider Details

I. General information

NPI: 1154572725
Provider Name (Legal Business Name): JENQ-SHENG LIU M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 CENTRAL AVE
SOUTH WILLIAMSON KY
41503-4121
US

IV. Provider business mailing address

414 CENTRAL AVE
SOUTH WILLIAMSON KY
41503-4121
US

V. Phone/Fax

Practice location:
  • Phone: 606-237-1214
  • Fax: 606-237-5819
Mailing address:
  • Phone: 606-237-1214
  • Fax: 606-237-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JENQ SHENG LIU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 606-237-1214