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General NPI Number Information
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NPI Number | 1699310516
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Entity Type | Organization
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Legal Business Name | ANN LIU LLC
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 17 N 18TH ST
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City | KENILWORTH
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State | NJ
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Zip | 07033-1230
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Country | US
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Telephone | 908-272-4170
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Fax | 908-272-1420
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Provider Business Mailing Address
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Address Line | 68 4TH ST APT 2A
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-1851
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Country | US
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Telephone | 832-264-1360
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANN LIU
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Credential | DMD
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Telephone | 832-264-1360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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