Provider Demographics
NPI:1740854462
Name:LIU, RYAN K
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:K
Last Name:LIU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8239 S 118TH CT
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-5181
Mailing Address - Country:US
Mailing Address - Phone:206-303-7158
Mailing Address - Fax:
Practice Address - Street 1:15428 SE 252ND PL
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4192
Practice Address - Country:US
Practice Address - Phone:206-480-6344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician