Healthcare Provider Details

I. General information

NPI: 1427264332
Provider Name (Legal Business Name): PETER H LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 POST ST SUITE 1252
SAN FRANCISCO CA
94102-1401
US

IV. Provider business mailing address

490 POST ST SUITE 1252
SAN FRANCISCO CA
94102-1401
US

V. Phone/Fax

Practice location:
  • Phone: 415-392-2020
  • Fax:
Mailing address:
  • Phone: 415-392-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: