Provider Demographics
NPI:1215036371
Name:LIU, YAN (MD)
Entity type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-0000
Mailing Address - Country:US
Mailing Address - Phone:607-723-1676
Mailing Address - Fax:607-772-6304
Practice Address - Street 1:40 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-0000
Practice Address - Country:US
Practice Address - Phone:607-723-1676
Practice Address - Fax:607-772-6304
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02815956Medicaid
I70787Medicare UPIN
NY02815956Medicaid