Provider Demographics
NPI:1437167046
Name:LIU, KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7029
Mailing Address - Country:US
Mailing Address - Phone:817-753-6888
Mailing Address - Fax:817-753-6885
Practice Address - Street 1:601 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7029
Practice Address - Country:US
Practice Address - Phone:817-753-6888
Practice Address - Fax:817-753-6885
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7801207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89078GOtherBCBS
TX00N59XOtherBLUE CROSS BLUE SHIELD
TX1036303-06Medicaid
TX8K4021OtherBLUE CROSS BLUE SHIELD
TX00N59XOtherBLUE CROSS BLUE SHIELD
TXH09489Medicare UPIN
TX612575Medicare PIN