Provider Demographics
NPI:1467864157
Name:LIU, XINGKUN (DDS,MS, PHD)
Entity Type:Individual
Prefix:
First Name:XINGKUN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:DDS,MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9889 BELLAIRE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3463
Mailing Address - Country:US
Mailing Address - Phone:281-501-0520
Mailing Address - Fax:281-501-0524
Practice Address - Street 1:9889 BELLAIRE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3464
Practice Address - Country:US
Practice Address - Phone:281-501-0520
Practice Address - Fax:281-501-0524
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3336919-11Medicaid