Provider Demographics
NPI:1518495373
Name:LIU, KIESAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KIESAN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KIESAN
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1835 UNIVERSITY BLVD E STE 230
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4657
Mailing Address - Country:US
Mailing Address - Phone:301-273-3781
Mailing Address - Fax:
Practice Address - Street 1:1835 UNIVERSITY BLVD E STE 230
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4657
Practice Address - Country:US
Practice Address - Phone:301-273-3781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03408111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation