Healthcare Provider Details

I. General information

NPI: 1235585795
Provider Name (Legal Business Name): SOPHIA YEONG LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 03/14/2024
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-5095
US

IV. Provider business mailing address

606 MEADOWWOOD DR SW
OLYMPIA WA
98502-2677
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2252
  • Fax:
Mailing address:
  • Phone: 949-217-9581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01079939A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD61278021
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: