Healthcare Provider Details

I. General information

NPI: 1679410419
Provider Name (Legal Business Name): RONGSHAN LIU DDS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 1ST AVE N
SEATTLE WA
98109-4001
US

IV. Provider business mailing address

5011 HARBOR LN
EVERETT WA
98203-1554
US

V. Phone/Fax

Practice location:
  • Phone: 626-636-5986
  • Fax:
Mailing address:
  • Phone: 626-636-5986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number70114855
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: