Provider Demographics
NPI:1578822789
Name:BRANDON M LIU MEDICAL SERVICE LLC
Entity Type:Organization
Organization Name:BRANDON M LIU MEDICAL SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:425-283-8895
Mailing Address - Street 1:11820 NORTHUP WAY
Mailing Address - Street 2:SUITE E226
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11820 NORTHUP WAY
Practice Address - Street 2:SUITE E226
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1946
Practice Address - Country:US
Practice Address - Phone:206-552-6992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60208496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty