MEDICARE: LIANA MAXA

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	171100000X	Acupuncturist	MD60251154	WA
2	207R00000X	Internal Medicine Physician	MD60251154	WA
3	208M00000X	Hospitalist Physician	MD60251154	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548417926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANA MAXA

Provider Business Mailing Address
First Line	:	1455 BATTERSBY AVE
Second Line	:
City	:	ENUMCLAW
State	:	WA
Zip	:	98022-3634
Country	:	US
Telephone Number	:	253-426-6341
Fax Number	:	360-697-2514

Provider Business Practice Location Address
First Line	:	1455 BATTERSBY AVE
Second Line	:
City	:	ENUMCLAW
State	:	WA
Zip	:	98022-3634
Country	:	US
Telephone Number	:	253-426-6341
Fax Number	:	360-697-2514

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

Provider Enumeration Date	:	08/27/2008
Last Update Date	:	03/24/2026

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1750499513 — JUN-BEOM KWON MD
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Directions to “ LIANA MAXA ” Practice Location

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