MEDICARE: KANG LIU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	132323	NY

General Provider Information

NPI Number	:	1245394105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANG LIU

Provider Business Mailing Address
First Line	:	387 CLINTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-3659
Country	:	US
Telephone Number	:	718-624-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	387 CLINTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-3659
Country	:	US
Telephone Number	:	718-624-2776
Fax Number	:	718-694-9681

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	12/02/2010

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Directions to “ KANG LIU ” Practice Location

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