Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | SP298 | CA |
NPI | 1336806173 |
---|---|
Provider Name | Hungchi Liao |
First Address | Loma Linda, CA 92354-2935 |
Second Address | San Bernardino, CA 92408-3348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2021 |
Last Update Date | 29/11/2021 |