Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 08090 | IA |
NPI | 1083817480 |
---|---|
Provider Name | Dr. Jack Chia Hsiang Liu |
First Address | Cedar Rapids, IA 52402-4831 |
Second Address | Cedar Rapids, IA 52402-4831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 08/07/2007 |