MEDICARE: DEREK XU LIANG DDS PLLC

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	261QD0000X	Dental Clinic/Center
2	122300000X	Dentist

General Provider Information

NPI Number	:	1275293821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEREK XU LIANG DDS PLLC

Provider Business Mailing Address
First Line	:	5226 KIAM ST UNIT 1015
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-1977
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 THIS WAY ST
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5140
Country	:	US
Telephone Number	:	832-458-1068
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DEREK LIANG
Credential	:	DDS
Telephone Number	:	832-316-0369

Provider Enumeration Date	:	12/22/2021
Last Update Date	:	06/14/2022

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