Provider Demographics
NPI:1962717652
Name:LIAO, KIMBERLY ABAYA (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ABAYA
Last Name:LIAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4211
Mailing Address - Country:US
Mailing Address - Phone:510-523-1995
Mailing Address - Fax:510-523-6155
Practice Address - Street 1:2042 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4211
Practice Address - Country:US
Practice Address - Phone:510-523-1995
Practice Address - Fax:510-523-6155
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist