MEDICARE: LIFE POWER GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1528662921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE POWER GROUP

Provider Business Mailing Address
First Line	:	11901 SANTA MONICA BLVD STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2783
Country	:	US
Telephone Number	:	626-986-8226
Fax Number	:

Provider Business Practice Location Address
First Line	:	11901 SANTA MONICA BLVD STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2783
Country	:	US
Telephone Number	:	626-986-8226
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. DU XU
Credential	:
Telephone Number	:	626-641-3736

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	11/25/2020

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