=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932211232
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MING-JAI LIU M.D., PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 05/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1757 E BASELINE RD STE 105
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85233-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-508-2700
-----------------------------------------------------
Fax | 866-371-2839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 72075
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85050-1018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-228-2306
-----------------------------------------------------
Fax | 505-485-0404
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP6422
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 47701
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------