Healthcare Provider Details

I. General information

NPI: 1871646992
Provider Name (Legal Business Name): KOFENG LIU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 MAIN ST SUITE100
FLUSHING NY
11354-5431
US

IV. Provider business mailing address

3915 MAIN ST SUITE100
FLUSHING NY
11354-5431
US

V. Phone/Fax

Practice location:
  • Phone: 718-353-3133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number048253
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: