Provider Demographics
NPI:1750359709
Name:LIU, JEFFREY EARL (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EARL
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 1:1380 LUSITANA ST.
Mailing Address - Street 2:SUITE 705
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2443
Mailing Address - Country:US
Mailing Address - Phone:808-537-5555
Mailing Address - Fax:808-537-5544
Practice Address - Street 1:1380 LUSITANA ST.
Practice Address - Street 2:SUITE 705
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2443
Practice Address - Country:US
Practice Address - Phone:808-537-5555
Practice Address - Fax:808-537-5544
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD86752084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03898302Medicaid
HI03898302Medicaid
0000BDWNVMedicare ID - Type Unspecified