Provider Demographics
NPI:1710967914
Name:LIU, MARK Y (DO, FAAFP)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:Y
Last Name:LIU
Suffix:
Gender:M
Credentials:DO, FAAFP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7210 ROOSEVELT WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5600
Mailing Address - Country:US
Mailing Address - Phone:206-215-3354
Mailing Address - Fax:206-320-7489
Practice Address - Street 1:7210 ROOSEVELT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5600
Practice Address - Country:US
Practice Address - Phone:206-215-3354
Practice Address - Fax:206-320-7489
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP1714207Q00000X
HIDOS-1207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000284265OtherHMSA BILLING NUMBER
WA208083OtherLABOR & INDUSTRIES
WA8449845Medicaid
HI632712-01Medicaid
WA5389LIOtherREGENCE BLUE SHIELD
WAOP1714OtherSTATE MEDICAL LICENSE
7710782OtherAETNA
P00338717OtherRAILROAD MEDICARE
WAG8860582Medicare PIN
WA8449845Medicaid
P00338717OtherRAILROAD MEDICARE
HIBT171ZMedicare PIN
7710782OtherAETNA
WA5389LIOtherREGENCE BLUE SHIELD