Provider Demographics
NPI:1609875566
Name:LIU, JENN YU (DO)
Entity Type:Individual
Prefix:
First Name:JENN
Middle Name:YU
Last Name:LIU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2001 COOLIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1378
Mailing Address - Country:US
Mailing Address - Phone:517-337-0316
Mailing Address - Fax:517-337-1779
Practice Address - Street 1:5100 MARSH RD STE H
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1195
Practice Address - Country:US
Practice Address - Phone:517-349-0150
Practice Address - Fax:517-349-0157
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2023-08-16
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
MI5101012517207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI180036069OtherRAILROAD MEDICARE
MI1853302054OtherBLUE CARE NETWORK OF MI
MI200000026818OtherPHP
MI180C36002OtherBCBSM
MI0800056OtherPHP OF MID MI
MI0870056OtherPHP FAMILY CARE
MI1853302054OtherMICHIGAN BCBS
MI3488767Medicaid
MI200000026818OtherPHP
MI180036069OtherRAILROAD MEDICARE
MI1853302054OtherMICHIGAN BCBS