Provider Demographics
NPI:1508987082
Name:LIU, KAN (MD)
Entity Type:Individual
Prefix:
First Name:KAN
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 1:7 HAMBLEN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421
Mailing Address - Country:US
Mailing Address - Phone:781-862-3060
Mailing Address - Fax:
Practice Address - Street 1:35 BEDFORD ST
Practice Address - Street 2:# 10
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4320
Practice Address - Country:US
Practice Address - Phone:781-862-8700
Practice Address - Fax:781-862-8701
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235393208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000699101Medicare PIN