Provider Demographics
NPI:1750551057
Name:LIAO, HSI-CHUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:HSI-CHUNG
Middle Name:
Last Name:LIAO
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:PO BOX 2004
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91778-2004
Mailing Address - Country:US
Mailing Address - Phone:626-679-4091
Mailing Address - Fax:
Practice Address - Street 1:680 E ALOSTA AVE STE 108
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2710
Practice Address - Country:US
Practice Address - Phone:626-679-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist