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General NPI Number Information
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NPI Number | 1609875566
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Entity Type | Individual
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Provider Name | JENN YU LIU DO
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 5100 MARSH RD STE H
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City | OKEMOS
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State | MI
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Zip | 48864-1195
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Country | US
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Telephone | 517-349-0150
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Fax | 517-349-0157
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Provider Business Mailing Address
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Address Line | 2001 COOLIDGE RD
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City | EAST LANSING
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State | MI
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Zip | 48823-1378
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Country | US
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Telephone | 517-337-0316
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Fax | 517-337-1779
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 5101012517
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License Number State | MI
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