Healthcare Provider Details

I. General information

NPI: 1558977413
Provider Name (Legal Business Name): JUNQING LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E STEWART AVE BLDG 2018
COLORADO SPRINGS CO
80914-2900
US

IV. Provider business mailing address

1055 E STEWART AVE BLDG 2018
COLORADO SPRINGS CO
80914-2900
US

V. Phone/Fax

Practice location:
  • Phone: 719-556-1333
  • Fax:
Mailing address:
  • Phone: 719-556-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: