MEDICARE: PHILIP LIAO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	58631	CA

General Provider Information

NPI Number	:	1043541121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP LIAO D.D.S.

Provider Business Mailing Address
First Line	:	345 9TH ST STE 302
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607-6523
Country	:	US
Telephone Number	:	510-986-6888
Fax Number	:	510-986-6816

Provider Business Practice Location Address
First Line	:	345 9TH ST STE 302
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607-6523
Country	:	US
Telephone Number	:	510-986-6888
Fax Number	:	510-986-6816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	01/28/2010

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