Healthcare Provider Details

I. General information

NPI: 1013098672
Provider Name (Legal Business Name): JOHN RICHARD LIU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 NE GILMAN BLVD
ISSAQUAH WA
98027-2937
US

IV. Provider business mailing address

185 NE GILMAN BLVD.
ISSAQUAH WA
98027-2937
US

V. Phone/Fax

Practice location:
  • Phone: 425-392-4048
  • Fax: 425-557-1138
Mailing address:
  • Phone: 425-392-4048
  • Fax: 425-557-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDE00006912
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: