Provider Demographics
NPI:1578509295
Name:LIU, JIAN HUA
Entity Type:Individual
Prefix:
First Name:JIAN HUA
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JIAN HUA
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:47 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3212
Mailing Address - Country:US
Mailing Address - Phone:617-987-0051
Mailing Address - Fax:
Practice Address - Street 1:720 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2393
Practice Address - Country:US
Practice Address - Phone:617-638-8906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207584363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0705411Medicaid
MAQ57359Medicare UPIN
MALI-NP5201Medicare ID - Type Unspecified