Healthcare Provider Details

I. General information

NPI: 1932700648
Provider Name (Legal Business Name): PEIXI LIAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18920 BOTHELL WAY NE STE 200
BOTHELL WA
98011-1981
US

IV. Provider business mailing address

18920 BOTHELL WAY NE STE 200
BOTHELL WA
98011-1981
US

V. Phone/Fax

Practice location:
  • Phone: 425-483-5838
  • Fax:
Mailing address:
  • Phone: 425-483-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE61421027
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: