1902989262 NPI number — PETER C. LIU D.D.S., INC.

Table of content: (NPI 1902989262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902989262 NPI number — PETER C. LIU D.D.S., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PETER C. LIU D.D.S., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WALNUT DENTAL SPECIALISTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902989262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18710 AMAR RD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91789-4571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-598-2999
Provider Business Mailing Address Fax Number:
626-965-9955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18710 AMAR RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91789-4571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-598-2999
Provider Business Practice Location Address Fax Number:
626-965-9955
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CABRAL
Authorized Official First Name:
NONI
Authorized Official Middle Name:
Authorized Official Title or Position:
FRONT OFFICE
Authorized Official Telephone Number:
909-598-2999

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  35917 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223E0200X , with the licence number: 53896 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0221X , with the licence number: 49934 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0300X , with the licence number: 38226 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X , with the licence number: 24358 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X , with the licence number: 41855 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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