Healthcare Provider Details

I. General information

NPI: 1639268063
Provider Name (Legal Business Name): PAUL CHEN LIU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 FOOTHILL BLVD
LA VERNE CA
91750-3027
US

IV. Provider business mailing address

2323 FOOTHILL BLVD
LA VERNE CA
91750-3027
US

V. Phone/Fax

Practice location:
  • Phone: 909-596-1861
  • Fax: 909-595-1569
Mailing address:
  • Phone: 909-596-1861
  • Fax: 909-595-1569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: