Provider Demographics
NPI:1093776635
Name:LIU, LU (PA)
Entity type:Individual
Prefix:
First Name:LU
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4277
Mailing Address - Country:US
Mailing Address - Phone:972-498-4791
Mailing Address - Fax:972-498-4939
Practice Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY STE 201
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4277
Practice Address - Country:US
Practice Address - Phone:972-498-4791
Practice Address - Fax:972-498-4939
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02204363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187944701Medicaid
TX187944701Medicaid
TX82N820Medicare PIN