Provider Demographics
NPI:1720073349
Name:LIU, DAVID DONGJIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DONGJIE
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 22389
Mailing Address - Street 2:PMB 82739
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37202
Mailing Address - Country:US
Mailing Address - Phone:866-315-2626
Mailing Address - Fax:
Practice Address - Street 1:410 S UNIVERSITY AVE # 160
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5246
Practice Address - Country:US
Practice Address - Phone:501-255-2482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-2195207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR18414000002OtherQUALCHOICE
110248506OtherRAILROAD MEDICARE
AR136440001Medicaid
AR01-20698OtherUNITED HEALTHCARE
G88261Medicare UPIN
AR5L115Medicare PIN