Healthcare Provider Details

I. General information

NPI: 1962025858
Provider Name (Legal Business Name): KATHY LIU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 RIDGELY AVE STE 206
ANNAPOLIS MD
21401-1083
US

IV. Provider business mailing address

6413 SNOWMAN CT
COLUMBIA MD
21045-4430
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-2660
  • Fax:
Mailing address:
  • Phone: 215-589-3747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17413
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: