Healthcare Provider Details

I. General information

NPI: 1487049847
Provider Name (Legal Business Name): DR. SHIH-YAO LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SEAN S LIU DDS, PHS, MSD

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24837 104TH AVE SE STE 200
KENT WA
98030-6800
US

IV. Provider business mailing address

24837 104TH AVE SE STE 200
KENT WA
98030-6800
US

V. Phone/Fax

Practice location:
  • Phone: 253-850-1234
  • Fax:
Mailing address:
  • Phone: 253-850-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number60503518
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: