Healthcare Provider Details

I. General information

NPI: 1013085273
Provider Name (Legal Business Name): MARK ADAM LIU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7911 41ST AVE SUITE A-107
ELMHURST NY
11373-1258
US

IV. Provider business mailing address

101 W 80TH ST APT 2F
NEW YORK NY
10024-7103
US

V. Phone/Fax

Practice location:
  • Phone: 718-205-2888
  • Fax:
Mailing address:
  • Phone: 646-934-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number051846
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: