Provider Demographics
NPI:1982896361
Name:LIU, KELLY DENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:DENNIS
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 1:1717 S J ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 CARROLL ST
Practice Address - Street 2:APT B7
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2064
Practice Address - Country:US
Practice Address - Phone:917-843-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60335778207R00000X, 208M00000X
MDD72514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine