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General NPI Number Information
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NPI Number | 1609916956
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Entity Type | Organization
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Legal Business Name | KUEI SHU LIAO D.D.S.INC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 680 E ALOSTA AVE STE 108
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City | AZUSA
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State | CA
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Zip | 91702-2710
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Country | US
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Telephone | 626-812-6612
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Fax |
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Provider Business Mailing Address
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Address Line | 680 E ALOSTA AVE STE 108
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City | AZUSA
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State | CA
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Zip | 91702-2710
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Country | US
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Telephone | 626-812-6612
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KUEI SHU LIAO
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Credential | DDS
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Telephone | 626-812-6612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 45136
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License Number State | CA
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