Healthcare Provider Details

I. General information

NPI: 1669288825
Provider Name (Legal Business Name): CHIH YEN LIU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA LIU DDS

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S ORCHARD ST
STILLWATER OK
74074-4218
US

IV. Provider business mailing address

1508 MORNING STAR
EDMOND OK
73034-6551
US

V. Phone/Fax

Practice location:
  • Phone: 512-734-7089
  • Fax:
Mailing address:
  • Phone: 512-734-7089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7979
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: