Healthcare Provider Details

I. General information

NPI: 1063998219
Provider Name (Legal Business Name): AVANT PLASTIC SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 WILSHIRE BLVD STE 100
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

PO BOX 1325
BEVERLY HILLS CA
90213-1325
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-3960
  • Fax: 310-382-2422
Mailing address:
  • Phone: 310-855-3960
  • Fax: 310-382-2422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA96604
License Number StateCA

VIII. Authorized Official

Name: DR. PERRY LIU
Title or Position: PRESIDENT
Credential: MD
Phone: 310-855-3960