Provider Demographics
NPI:1609916956
Name:KUEI SHU LIAO D.D.S.INC
Entity Type:Organization
Organization Name:KUEI SHU LIAO D.D.S.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KUEI
Authorized Official - Middle Name:SHU
Authorized Official - Last Name:LIAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-812-6612
Mailing Address - Street 1:680 E ALOSTA AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2710
Mailing Address - Country:US
Mailing Address - Phone:626-812-6612
Mailing Address - Fax:
Practice Address - Street 1:680 E ALOSTA AVE STE 108
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2710
Practice Address - Country:US
Practice Address - Phone:626-812-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451361223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty