Provider Demographics
NPI:1992830665
Name:AU, CLARENCE KWOK-LIANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:KWOK-LIANG
Last Name:AU
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 1:8604 CHAUMONT CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1502
Mailing Address - Country:US
Mailing Address - Phone:661-665-9140
Mailing Address - Fax:661-631-1116
Practice Address - Street 1:2007 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4203
Practice Address - Country:US
Practice Address - Phone:661-631-1113
Practice Address - Fax:661-631-1116
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93989-01OtherDENTI-CAL PROVIDER NUMBER
CA34463OtherSTATE LICENSE