Healthcare Provider Details

I. General information

NPI: 1346926938
Provider Name (Legal Business Name): YUAN YUAN LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY LIU

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S 333RD ST STE 130
FEDERAL WAY WA
98003-6073
US

IV. Provider business mailing address

415 ST HELENS AVE APT 636
TACOMA WA
98402-2443
US

V. Phone/Fax

Practice location:
  • Phone: 650-804-1658
  • Fax:
Mailing address:
  • Phone: 650-804-1658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61448751
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: