Healthcare Provider Details

I. General information

NPI: 1457467268
Provider Name (Legal Business Name): WU YEN LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WAYNE LIU MD

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 BRANCH AVENUE SUITE 305
TEMPLE HILLS MD
20748-1242
US

IV. Provider business mailing address

3611 BRANCH AVENUE SUITE 305
TEMPLE HILLS MD
20748-1242
US

V. Phone/Fax

Practice location:
  • Phone: 301-423-5540
  • Fax: 301-423-8491
Mailing address:
  • Phone: 301-423-5540
  • Fax: 301-423-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD0026605
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD12997
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: