Healthcare Provider Details

I. General information

NPI: 1942543079
Provider Name (Legal Business Name): LIU DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5527 CLAIREMONT MESA BLVD
SAN DIEGO CA
92117-2342
US

IV. Provider business mailing address

5527 CLAIREMONT MESA BLVD
SAN DIEGO CA
92117-2342
US

V. Phone/Fax

Practice location:
  • Phone: 858-467-0503
  • Fax: 858-467-9103
Mailing address:
  • Phone: 858-467-0503
  • Fax: 858-467-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number41461
License Number StateCA

VIII. Authorized Official

Name: MOLLY S. LIU
Title or Position: OWNER
Credential: D.D.S.
Phone: 858-467-0503