Provider Demographics
NPI:1174632392
Name:GENE S J LIAW MD PS
Entity Type:Organization
Organization Name:GENE S J LIAW MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-623-0733
Mailing Address - Street 1:662A S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-623-0733
Mailing Address - Fax:206-623-1014
Practice Address - Street 1:662A S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-623-0733
Practice Address - Fax:206-623-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022484208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1026715Medicaid
WAG8801034Medicare ID - Type Unspecified
WA1026715Medicaid