Provider Demographics
NPI:1639368608
Name:LIU-KIM, YISHO (DDS)
Entity Type:Individual
Prefix:DR
First Name:YISHO
Middle Name:
Last Name:LIU-KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:YI HSIU
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:17401 DRAKE ST
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1879
Mailing Address - Country:US
Mailing Address - Phone:714-293-0289
Mailing Address - Fax:
Practice Address - Street 1:17401 DRAKE ST
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1879
Practice Address - Country:US
Practice Address - Phone:714-293-0289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice