Provider Demographics
NPI:1407840523
Name:LIAO, KUEI SHU (DDS)
Entity Type:Individual
Prefix:DR
First Name:KUEI SHU
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 1:2253 OLDRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-5627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8300 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2651
Practice Address - Country:US
Practice Address - Phone:626-573-3616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery