Healthcare Provider Details

I. General information

NPI: 1265634000
Provider Name (Legal Business Name): ALEX LIAO, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 E ALOSTA AVE STE 108
AZUSA CA
91702-2710
US

IV. Provider business mailing address

680 E ALOSTA AVE #108
AZUSA CA
91702
US

V. Phone/Fax

Practice location:
  • Phone: 626-812-6612
  • Fax: 626-812-6634
Mailing address:
  • Phone: 626-812-6612
  • Fax: 626-812-6634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number45136
License Number StateCA

VIII. Authorized Official

Name: MS. VIKKY FUNG
Title or Position: PUBLIC RELATIONS
Credential:
Phone: 626-812-6612