Provider Demographics
NPI:1669653721
Name:LIU, KAI RONG JOHNNY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAI RONG JOHNNY
Middle Name:
Last Name:LIU
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 1:7600 DUBLIN BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2909
Mailing Address - Country:US
Mailing Address - Phone:925-833-8838
Mailing Address - Fax:925-833-8075
Practice Address - Street 1:7600 DUBLIN BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2909
Practice Address - Country:US
Practice Address - Phone:925-833-8838
Practice Address - Fax:925-833-8075
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist