Healthcare Provider Details

I. General information

NPI: 1972131316
Provider Name (Legal Business Name): KEVIN ZHU LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8066 WALNUT RUN RD STE 101
CORDOVA TN
38018-8842
US

IV. Provider business mailing address

3035 N HIGHLAND AVE
JACKSON TN
38305-3411
US

V. Phone/Fax

Practice location:
  • Phone: 800-224-1807
  • Fax: 731-664-0946
Mailing address:
  • Phone: 731-664-0899
  • Fax: 731-664-0946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35298
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number71094
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: