Provider Demographics
NPI:1265659122
Name:LIAO, CHUN YAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHUN YAO
Middle Name:
Last Name:LIAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice