Healthcare Provider Details

I. General information

NPI: 1568567626
Provider Name (Legal Business Name): DAI-CHEN LIU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20445 PROSPECT RD STE 7
SAN JOSE CA
95129-4663
US

IV. Provider business mailing address

20445 PROSPECT RD STE 7
SAN JOSE CA
95129-4663
US

V. Phone/Fax

Practice location:
  • Phone: 408-252-8889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: