Provider Demographics
NPI:1821529769
Name:LIU, RUIKANG (MD)
Entity Type:Individual
Prefix:DR
First Name:RUIKANG
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KONG KONG
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4481 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-7414
Mailing Address - Country:US
Mailing Address - Phone:318-626-2593
Mailing Address - Fax:318-399-7716
Practice Address - Street 1:4481 VIKING DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-7414
Practice Address - Country:US
Practice Address - Phone:318-626-2593
Practice Address - Fax:318-399-7716
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA333597208000000X, 2080S0010X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine