Provider Demographics
NPI:1720020977
Name:LIU, JAMES KUO-LI (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KUO-LI
Last Name:LIU
Suffix:
Gender:M
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:PO BOX 472423
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28247-2423
Mailing Address - Country:US
Mailing Address - Phone:704-321-2741
Mailing Address - Fax:704-542-9991
Practice Address - Street 1:11220 ELM LN STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0450
Practice Address - Country:US
Practice Address - Phone:704-321-2741
Practice Address - Fax:704-542-9991
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23593207RC0000X
NC200200945207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89133EAMedicaid
SCN0094AMedicaid
NCP00612430OtherRAILROAD MEDICARE
NC133EAOtherBCBS
SCH730705332Medicare ID - Type Unspecified
NC2007711BMedicare PIN
SCH730757772Medicare PIN
NCP00612430OtherRAILROAD MEDICARE
NC2007711Medicare ID - Type Unspecified
NC2007711CMedicare PIN
SCH730758186Medicare PIN