Healthcare Provider Details

I. General information

NPI: 1245432640
Provider Name (Legal Business Name): SHEAU CHRISTINE LIU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 N TOMAHAWK ISLAND DR STE 105
PORTLAND OR
97217-8096
US

IV. Provider business mailing address

510 SW 167TH AVE
BEAVERTON OR
97006-7960
US

V. Phone/Fax

Practice location:
  • Phone: 503-289-1215
  • Fax:
Mailing address:
  • Phone: 503-690-0577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7770
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: