Provider Demographics
NPI:1467090852
Name:LIU, JENSAN
Entity Type:Individual
Prefix:
First Name:JENSAN
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 1:14735 38TH AVE APT B36
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4869
Mailing Address - Country:US
Mailing Address - Phone:917-378-1603
Mailing Address - Fax:
Practice Address - Street 1:376 VAN BRUNT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-1235
Practice Address - Country:US
Practice Address - Phone:718-797-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy