Provider Demographics
NPI:1568554301
Name:KEEN, LIYEN LIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIYEN
Middle Name:LIN
Last Name:KEEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LI-YEN
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:17320 W GRAND PKWY S STE B
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2667
Mailing Address - Country:US
Mailing Address - Phone:832-595-2505
Mailing Address - Fax:832-595-2290
Practice Address - Street 1:17320 W GRAND PKWY S
Practice Address - Street 2:STE. B
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2666
Practice Address - Country:US
Practice Address - Phone:832-595-2505
Practice Address - Fax:832-595-2290
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1444952 03Medicaid
TXB205851OtherTX CHIP IDENTIFIER NUMBER