Provider Demographics
NPI:1891904033
Name:LIU, KANGSHAN (MDDDS)
Entity Type:Individual
Prefix:
First Name:KANGSHAN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:MDDDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:CA
Mailing Address - Zip Code:94010-7328
Mailing Address - Country:US
Mailing Address - Phone:650-898-9191
Mailing Address - Fax:
Practice Address - Street 1:20395 PACIFICA DR
Practice Address - Street 2:SUITE 109
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3016
Practice Address - Country:US
Practice Address - Phone:408-996-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA544191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice