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General NPI Number Information
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NPI Number | 1104875483
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Entity Type | Individual
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Provider Name | XIAO DA LIU MD
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Gender | Male
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Dates
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Enumeration Date | 05/06/2006
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Last Update Date | 12/07/2025
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Provider Practice Location Address
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Address Line | 31 TEC ST
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City | HICKSVILLE
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State | NY
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Zip | 11801-3618
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Country | US
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Telephone | 516-478-9303
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Fax | 516-932-3672
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Provider Business Mailing Address
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Address Line | 152 73RD ST
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City | BROOKLYN
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State | NY
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Zip | 11209-2202
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Country | US
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Telephone | 718-836-6964
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Fax | 718-836-6964
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A174112-1
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License Number State | NY
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