Provider Demographics
NPI:1043613953
Name:CHUN YAO LIAO DENTAL CORPORATION
Entity Type:Organization
Organization Name:CHUN YAO LIAO DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUN
Authorized Official - Middle Name:YAO
Authorized Official - Last Name:LIAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-810-2691
Mailing Address - Street 1:2420 S AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1512
Mailing Address - Country:US
Mailing Address - Phone:626-810-2691
Mailing Address - Fax:626-839-0088
Practice Address - Street 1:2420 S AZUSA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1512
Practice Address - Country:US
Practice Address - Phone:626-810-2691
Practice Address - Fax:626-839-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37443OtherMEDICAL