Provider Demographics
NPI:1316908577
Name:LIOU-BECKLES, KASSIE MEI-JIUN
Entity type:Individual
Prefix:
First Name:KASSIE
Middle Name:MEI-JIUN
Last Name:LIOU-BECKLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KASSIE
Other - Middle Name:MEI-JIUN
Other - Last Name:LIOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1320 GREENWAY DR
Mailing Address - Street 2:STE 200
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2503
Mailing Address - Country:US
Mailing Address - Phone:972-550-9195
Mailing Address - Fax:972-550-0079
Practice Address - Street 1:1600 COIT RD
Practice Address - Street 2:STE 309
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6174
Practice Address - Country:US
Practice Address - Phone:972-596-6676
Practice Address - Fax:972-596-7078
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04408363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8E0325Medicare ID - Type Unspecified
TXP03884Medicare UPIN