Provider Demographics
NPI:1396838090
Name:DU, LIENG KIM (MD)
Entity Type:Individual
Prefix:MRS
First Name:LIENG
Middle Name:KIM
Last Name:DU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 NORTH U STREET
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505
Mailing Address - Country:US
Mailing Address - Phone:850-433-6514
Mailing Address - Fax:850-436-6720
Practice Address - Street 1:907 NORTH U STREET
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505
Practice Address - Country:US
Practice Address - Phone:850-433-6514
Practice Address - Fax:850-436-6720
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50398208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07074OtherBLUE CROSS BLUE SHIELD
FLD61463Medicare UPIN
FL07074Medicare ID - Type Unspecified