MEDICARE: SUE-CHIN LIU, DMD, PHD, PC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D7125	OR

General Provider Information

NPI Number	:	1154321081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUE-CHIN LIU, DMD, PHD, PC

Provider Business Mailing Address
First Line	:	15160 NW LAIDLAW RD
Second Line	:	SUITE 200
City	:	PORTLAND
State	:	OR
Zip	:	97229-7707
Country	:	US
Telephone Number	:	503-614-8898
Fax Number	:	503-690-9072

Provider Business Practice Location Address
First Line	:	15160 NW LAIDLAW RD
Second Line	:	SUITE 200
City	:	PORTLAND
State	:	OR
Zip	:	97229-7707
Country	:	US
Telephone Number	:	503-614-8898
Fax Number	:	503-690-9072

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUE-CHIN LIU
Credential	:	DMD PHD
Telephone Number	:	503-614-8898

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	08/22/2020

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