Provider Demographics
NPI:1104875483
Name:LIU, XIAO DA (MD)
Entity type:Individual
Prefix:DR
First Name:XIAO
Middle Name:DA
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:152 73RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2202
Mailing Address - Country:US
Mailing Address - Phone:718-836-6964
Mailing Address - Fax:718-836-6964
Practice Address - Street 1:31 TEC ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3618
Practice Address - Country:US
Practice Address - Phone:516-478-9303
Practice Address - Fax:516-932-3672
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYA174112-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF20601Medicare UPIN
NY10614Medicare ID - Type Unspecified