Provider Demographics
NPI:1679276174
Name:LIU, WAN
Entity type:Individual
Prefix:
First Name:WAN
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 W RIVERSIDE AVE UNIT 1137
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-0330
Mailing Address - Country:US
Mailing Address - Phone:510-910-4449
Mailing Address - Fax:
Practice Address - Street 1:27528 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542-2328
Practice Address - Country:US
Practice Address - Phone:510-910-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician