Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 53822 | CA |
N | 213EG0000X | General Practice | 53822 | CA |
Y | 1223X0400X | Orthodontists | 53822 | CA |
NPI | 1033241161 |
---|---|
Provider Name | Kenny Liu |
First Address | Alhambra, CA 91801-1810 |
Second Address | Alhambra, CA 91801-1810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 25/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D53822 | DENTI-CAL PROVIDER NUMBER (01) | CA |