Provider Demographics
NPI:1609234624
Name:LIU, YING (PA)
Entity Type:Individual
Prefix:MS
First Name:YING
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-991-4644
Mailing Address - Fax:866-342-0133
Practice Address - Street 1:555 N NEW BALLAS RD
Practice Address - Street 2:DIV SURG COLON/RECTAL, STE 265
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6825
Practice Address - Country:US
Practice Address - Phone:314-991-4644
Practice Address - Fax:866-342-0133
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015038426363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220089586Medicaid