Basic Information
| Provider Information | |||||||||
| NPI: | 1548275472 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIU | ||||||||
| FirstName: | SAO | ||||||||
| MiddleName: | JANG | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11606 NICHOLAS ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681544478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024933712 | ||||||||
| FaxNumber: | 4024938341 | ||||||||
| Practice Location | |||||||||
| Address1: | 11606 NICHOLAS ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681544478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024933712 | ||||||||
| FaxNumber: | 4024938341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 17650 | NE | Y | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 27300 | IA | N | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 916940 | 01 | IA | WELLMARK | OTHER | 0800063 | 01 | NE | UNITED HEALTHCARE | OTHER | 4141937 | 01 | IA | IOWA MEDICAID | OTHER | 35480 | 01 | NE | BLUE CROSS & BLUE SHIELD | OTHER | 47084218400 | 05 | NE | MEDICAID | I3130 | 01 | IA | IOWA MEDICARE | OTHER | 1676 | 01 | NE | MIDLANDS CHOICE | OTHER |