Provider Demographics
NPI:1922293935
Name:LIU, JENNIFER JUO TZU (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JUO TZU
Last Name:LIU
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Gender:F
Credentials:DDS MD
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Mailing Address - Street 1:1700 PENNSYLVANIA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3588
Mailing Address - Country:US
Mailing Address - Phone:707-422-6020
Mailing Address - Fax:707-422-7228
Practice Address - Street 1:1700 PENNSYLVANIA AVE
Practice Address - Street 2:STE A
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3588
Practice Address - Country:US
Practice Address - Phone:707-422-6020
Practice Address - Fax:707-422-7228
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2015-06-10
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Provider Licenses
StateLicense IDTaxonomies
CAOMS75204E00000X
CAA99211208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice