Provider Demographics
NPI:1962714766
Name:LIU, QUAN (DDS, PHD, DMD)
Entity type:Individual
Prefix:
First Name:QUAN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:DDS, PHD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7506 CHARMANT DR
Mailing Address - Street 2:818
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5026
Mailing Address - Country:US
Mailing Address - Phone:858-610-3403
Mailing Address - Fax:
Practice Address - Street 1:7506 CHARMANT DR
Practice Address - Street 2:818
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5026
Practice Address - Country:US
Practice Address - Phone:858-610-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice