Healthcare Provider Details

I. General information

NPI: 1639438567
Provider Name (Legal Business Name): MOFEI LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2012
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOONE RD
BREMERTON WA
98312-1894
US

IV. Provider business mailing address

1 BOONE RD
BREMERTON WA
98312-1894
US

V. Phone/Fax

Practice location:
  • Phone: 360-475-4000
  • Fax:
Mailing address:
  • Phone: 360-475-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number60897037
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: