1023338068 NPI number — MR. SHAWN SHUKUANG LIU M.D.

Table of content: MR. SHAWN SHUKUANG LIU M.D. (NPI 1023338068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023338068 NPI number — MR. SHAWN SHUKUANG LIU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIU
Provider First Name:
SHAWN
Provider Middle Name:
SHUKUANG
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIU
Provider Other First Name:
SHUKUANG
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023338068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 ADAMS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN SQUARE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11010-2248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 FIRST AVE
Provider Second Line Business Practice Location Address:
NYU LANGONE MEDICAL CENTER
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-263-5506
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0101X , with the licence number:  255378 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)