Provider Demographics
NPI:1083349450
Name:LIU, KEVIN (NP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 WESTVIEW CRES
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-1012
Mailing Address - Country:US
Mailing Address - Phone:585-752-5568
Mailing Address - Fax:
Practice Address - Street 1:50 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9312
Practice Address - Country:US
Practice Address - Phone:585-321-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily