Healthcare Provider Details

I. General information

NPI: 1396285953
Provider Name (Legal Business Name): GEOFFREY KUO-CHANG LIU D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21680 RAINBOW CT
CUPERTINO CA
95014-4829
US

IV. Provider business mailing address

21680 RAINBOW CT
CUPERTINO CA
95014-4829
US

V. Phone/Fax

Practice location:
  • Phone: 408-410-0993
  • Fax:
Mailing address:
  • Phone: 408-410-0993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number48823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: