Healthcare Provider Details

I. General information

NPI: 1255053872
Provider Name (Legal Business Name): JOSEPHINE LIU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47000 WARM SPRINGS BLVD STE 2
FREMONT CA
94539-7467
US

IV. Provider business mailing address

557 THAIN WAY
PALO ALTO CA
94306-3921
US

V. Phone/Fax

Practice location:
  • Phone: 650-793-8385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number107934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: