Healthcare Provider Details

I. General information

NPI: 1942123914
Provider Name (Legal Business Name): XIYAO LIU DENTAL HYGIENIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 68TH ST FL 3
BROOKLYN NY
11204-4752
US

IV. Provider business mailing address

2171 68TH ST FL 3
BROOKLYN NY
11204-4752
US

V. Phone/Fax

Practice location:
  • Phone: 347-713-1828
  • Fax: 347-713-1878
Mailing address:
  • Phone: 347-713-1828
  • Fax: 347-713-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number028759
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: