Provider Demographics
NPI:1891226635
Name:LIU, YITONG ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:YITONG
Middle Name:ALBERT
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:WUSM PEDS NEPHROLOGY
Mailing Address - Street 2:1 CHILDRENS PL CB 8116
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-454-6043
Mailing Address - Fax:888-463-6898
Practice Address - Street 1:1 CHILDRENS PL CB 8116
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-454-6043
Practice Address - Fax:888-463-6898
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI69959208000000X
MO2021011324208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics