Provider Demographics
NPI:1598937435
Name:YAN LIU, M.D., PLLC
Entity Type:Organization
Organization Name:YAN LIU, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-484-9330
Mailing Address - Street 1:212 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6204
Mailing Address - Country:US
Mailing Address - Phone:716-484-9330
Mailing Address - Fax:
Practice Address - Street 1:212 FRONT STREET
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701
Practice Address - Country:US
Practice Address - Phone:716-484-9330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220487174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000526387002OtherBLUE CROSS
NY02158721Medicaid
NY0411358OtherINDEPENDENT HEALTH
NY000255434002OtherUNIVERA
NYAA1158OtherMEDICARE PIN
NY000526387002OtherBLUE CROSS