Provider Demographics
NPI:1124432695
Name:LIU, CHUNHUA CHILTON
Entity type:Individual
Prefix:
First Name:CHUNHUA
Middle Name:CHILTON
Last Name:LIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 BRIMLEY WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1616
Mailing Address - Country:US
Mailing Address - Phone:909-353-8291
Mailing Address - Fax:707-678-3026
Practice Address - Street 1:1285 STRATFORD AVE STE A
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-2001
Practice Address - Country:US
Practice Address - Phone:707-678-3065
Practice Address - Fax:707-678-3026
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA634961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice