Provider Demographics
NPI:1245394105
Name:LIU, KANG
Entity Type:Individual
Prefix:
First Name:KANG
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3659
Mailing Address - Country:US
Mailing Address - Phone:718-624-2776
Mailing Address - Fax:
Practice Address - Street 1:387 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3659
Practice Address - Country:US
Practice Address - Phone:718-624-2776
Practice Address - Fax:718-694-9681
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132323207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02A211Medicare ID - Type Unspecified
NYCO4535Medicare UPIN