Healthcare Provider Details

I. General information

NPI: 1730409459
Provider Name (Legal Business Name): EVAN YOUNG LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 N FEATHERING LN
MEDIA PA
19063-1967
US

IV. Provider business mailing address

2360 N FEATHERING LN
MEDIA PA
19063-1967
US

V. Phone/Fax

Practice location:
  • Phone: 610-357-0510
  • Fax:
Mailing address:
  • Phone: 610-357-0510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD039813E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: