Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 38965 | NY |
NPI | 1033211073 |
---|---|
Provider Name | Dr. Kenneth K Liao |
First Address | Hewlett, NY 11557-2014 |
Second Address | Hewlett, NY 11557-2014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |