Healthcare Provider Details

I. General information

NPI: 1972764157
Provider Name (Legal Business Name): WENDY PEIWEN LIAO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 SANTA CLARA AVE
ALAMEDA CA
94501
US

IV. Provider business mailing address

2525 SANTA CLARA AVE
ALAMEDA CA
94501
US

V. Phone/Fax

Practice location:
  • Phone: 510-865-1114
  • Fax: 510-227-6212
Mailing address:
  • Phone: 510-865-1114
  • Fax: 510-227-6212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number53818
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number53818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: