MEDICARE: JUDITH AGUILAR LIAO DDS

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	36880	CA

General Provider Information

NPI Number	:	1821188699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH AGUILAR LIAO DDS

Provider Business Mailing Address
First Line	:	128 BRENTWOOD DR
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-5717
Country	:	US
Telephone Number	:	650-757-6688
Fax Number	:	650-757-6556

Provider Business Practice Location Address
First Line	:	128 BRENTWOOD DR
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-5717
Country	:	US
Telephone Number	:	650-757-6688
Fax Number	:	650-757-6556

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	10/22/2025

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