Provider Demographics
NPI:1154572725
Name:JENQ-SHENG LIU M.D. INC
Entity type:Organization
Organization Name:JENQ-SHENG LIU M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENQ
Authorized Official - Middle Name:SHENG
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-237-1214
Mailing Address - Street 1:414 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4121
Mailing Address - Country:US
Mailing Address - Phone:606-237-1214
Mailing Address - Fax:606-237-5819
Practice Address - Street 1:414 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4121
Practice Address - Country:US
Practice Address - Phone:606-237-1214
Practice Address - Fax:606-237-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64192487Medicaid
WV0094347000Medicaid
KY64192487Medicaid