Healthcare Provider Details

I. General information

NPI: 1396587853
Provider Name (Legal Business Name): YANNI LIU RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E 95TH ST
NEW YORK NY
10128-4014
US

IV. Provider business mailing address

205 E 95TH ST APT 3C
NEW YORK NY
10128-4063
US

V. Phone/Fax

Practice location:
  • Phone: 929-637-3374
  • Fax:
Mailing address:
  • Phone: 512-517-4205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86177133
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: