Healthcare Provider Details

I. General information

NPI: 1558252999
Provider Name (Legal Business Name): YUNCHAO LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BALTIMORE ANNAPOLIS BLVD
SEVERNA PARK MD
21146-3970
US

IV. Provider business mailing address

1 E UNIVERSITY PKWY UNIT 210
BALTIMORE MD
21218-2417
US

V. Phone/Fax

Practice location:
  • Phone: 410-553-4450
  • Fax:
Mailing address:
  • Phone: 813-600-9636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP16705
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: