Healthcare Provider Details

I. General information

NPI: 1619724846
Provider Name (Legal Business Name): TIMOTHY C LIU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E MEEKER ST STE 100
KENT WA
98030-5904
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 253-796-4071
  • Fax: 253-796-4076
Mailing address:
  • Phone: 425-277-1311
  • Fax: 425-277-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberWA61691355
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: