Provider Demographics
NPI:1871733618
Name:LIU, KAI WING (RPH)
Entity type:Individual
Prefix:MR
First Name:KAI
Middle Name:WING
Last Name:LIU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 82ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3007
Mailing Address - Country:US
Mailing Address - Phone:212-219-2717
Mailing Address - Fax:
Practice Address - Street 1:36 GOUVERNEUR ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-5763
Practice Address - Country:US
Practice Address - Phone:212-385-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist