1811057284 NPI number — LLOYD K. LIU DMD, PC

Table of content: (NPI 1811057284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811057284 NPI number — LLOYD K. LIU DMD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LLOYD K. LIU DMD, PC
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:
Provider Other Organization Name Type Code:
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:
1811057284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
432 EAST 12300 SOUTH
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
DRAPER
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-553-2588
Provider Business Mailing Address Fax Number:
801-553-2100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
432 EAST 12300 SOUTH
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
DRAPER
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-553-2588
Provider Business Practice Location Address Fax Number:
801-553-2100
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIU
Authorized Official First Name:
LLOYD
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
PRESIDENT OF CORPORATION
Authorized Official Telephone Number:
801-553-2588

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  89-144630-9921 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 789803 . This is a "UNITED CONCORDIA TRICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 144630 . This is a "DELTA DENTAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 528904611024 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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