Healthcare Provider Details

I. General information

NPI: 1629760194
Provider Name (Legal Business Name): LIUYICHEN PU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 NOB HILL DR APT J
BIRMINGHAM AL
35209-1430
US

IV. Provider business mailing address

818 NOB HILL DR APT J
BIRMINGHAM AL
35209-1430
US

V. Phone/Fax

Practice location:
  • Phone: 443-248-3204
  • Fax:
Mailing address:
  • Phone: 443-248-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18899
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: