Provider Demographics
NPI:1609907948
Name:LIU, WING YI (MD)
Entity Type:Individual
Prefix:
First Name:WING YI
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 N CAUSEWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5303
Mailing Address - Country:US
Mailing Address - Phone:386-424-8440
Mailing Address - Fax:
Practice Address - Street 1:161 N CAUSEWAY
Practice Address - Street 2:SUITE C
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5303
Practice Address - Country:US
Practice Address - Phone:386-424-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97585207RC0000X
TXM5331207RC0000X
FLME 97585207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000887600Medicaid
FL000887600Medicaid