Healthcare Provider Details

I. General information

NPI: 1649403130
Provider Name (Legal Business Name): CHANG LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CORDAGE PARK CIRCLE
PLYMOUTH MA
02360
US

IV. Provider business mailing address

36 CORDAGE PARK CIR
PLYMOUTH MA
02360-7331
US

V. Phone/Fax

Practice location:
  • Phone: 781-917-4606
  • Fax:
Mailing address:
  • Phone: 781-917-4606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: