Provider Demographics
NPI:1932271194
Name:LIU, RICHARD WEN-JOU (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WEN-JOU
Last Name:LIU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:WEN-JOU
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 KAMOKILA BLVD
Mailing Address - Street 2:KAPOLEI BLDG.#109
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2014
Mailing Address - Country:US
Mailing Address - Phone:808-674-8000
Mailing Address - Fax:808-674-8607
Practice Address - Street 1:1001 KAMOKILA BLVD
Practice Address - Street 2:KAPOLEI BLDG.#109
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2014
Practice Address - Country:US
Practice Address - Phone:808-674-8000
Practice Address - Fax:808-674-8607
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-17031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDT-1703OtherDENTAL LICENSE