Provider Demographics
NPI:1962993824
Name:LIU, GARY GANG (DMD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:GANG
Last Name:LIU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24970 KEISSEL RD
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-9687
Mailing Address - Country:US
Mailing Address - Phone:909-247-4258
Mailing Address - Fax:
Practice Address - Street 1:10602 CHAPMAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3147
Practice Address - Country:US
Practice Address - Phone:714-537-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1025971223P0221X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program