Provider Demographics
NPI:1871656272
Name:THIO, LIU LIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LIU LIN
Middle Name:
Last Name:THIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KWEE
Other - Middle Name:
Other - Last Name:THIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8111
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-4089
Mailing Address - Fax:314-454-4225
Practice Address - Street 1:1 CHILDRENS PL STE 2D
Practice Address - Street 2:STE 2D
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-4089
Practice Address - Fax:314-454-4225
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1010902084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid
MO204719603Medicaid
MO127010101Medicare PIN
MO127010101Medicaid