Provider Demographics
NPI:1386851251
Name:LIU, XIAOGUANG (MD)
Entity type:Individual
Prefix:DR
First Name:XIAOGUANG
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 FORT WASHINGTON AVE APT 3N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3745
Mailing Address - Country:US
Mailing Address - Phone:718-530-5267
Mailing Address - Fax:646-669-8192
Practice Address - Street 1:427 FORT WASHINGTON AVE APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3522
Practice Address - Country:US
Practice Address - Phone:718-530-5267
Practice Address - Fax:646-669-8192
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233485208100000X, 2081H0002X
NJ25MA082411002081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY121XEY201Medicare UPIN
NY121X56L911Medicare UPIN
NY121X56L912Medicare UPIN