Healthcare Provider Details

I. General information

NPI: 1679069660
Provider Name (Legal Business Name): KENNETH LIU DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 03/30/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 SOUTHLAKE PKWY STE 201
HOOVER AL
35244-3645
US

IV. Provider business mailing address

4501 SOUTHLAKE PKWY STE 201
HOOVER AL
35244-3645
US

V. Phone/Fax

Practice location:
  • Phone: 205-822-3222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number26152
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD.0006524-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: