Healthcare Provider Details

I. General information

NPI: 1194831545
Provider Name (Legal Business Name): SU-CHIEH LIU D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 YALE ST FL 2B
PALO ALTO CA
94306-1448
US

IV. Provider business mailing address

2345 YALE ST FL 2B
PALO ALTO CA
94306-1448
US

V. Phone/Fax

Practice location:
  • Phone: 650-351-6789
  • Fax: 650-351-6498
Mailing address:
  • Phone: 650-351-6789
  • Fax: 650-351-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number44925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: