Healthcare Provider Details

I. General information

NPI: 1942019815
Provider Name (Legal Business Name): YONGYI LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2025
Last Update Date: 01/29/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136-08 NORTHERN BLVD
FLUSHING NY
11354
US

IV. Provider business mailing address

1535 74TH ST
BROOKLYN NY
11228-2220
US

V. Phone/Fax

Practice location:
  • Phone: 718-799-0928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number072375
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: