Healthcare Provider Details

I. General information

NPI: 1982977179
Provider Name (Legal Business Name): HOTA EDWARD LIU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 WEST CHELTEN AVE SUITE #1
PHILADELPHIA PA
19144
US

IV. Provider business mailing address

515 W. CHELTEN AVE, SUITE 1
PHILADELPHIA PA
19144
US

V. Phone/Fax

Practice location:
  • Phone: 215-438-3040
  • Fax:
Mailing address:
  • Phone: 215-438-3040
  • Fax: 215-438-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number232-53-7128
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: