Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN014431 | GA |
NPI | 1003170135 |
---|---|
Provider Name | Dr. Chu Kai Liang |
First Address | Norcross, GA 30093-1752 |
Second Address | Norcross, GA 30093-1752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2012 |
Last Update Date | 03/07/2012 |