Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DE00006912 | WA |
NPI | 1013098672 |
---|---|
Provider Name | Dr. John Richard Liu |
First Address | Issaquah, WA 98027-2937 |
Second Address | Issaquah, WA 98027-2937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |