Healthcare Provider Details

I. General information

NPI: 1891546560
Provider Name (Legal Business Name): LIU MAKAN DOWNEY DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 PARAMOUNT BLVD
DOWNEY CA
90241-3303
US

IV. Provider business mailing address

1908 RUE LE CHARLENE
RANCHO PALOS VERDES CA
90275-6372
US

V. Phone/Fax

Practice location:
  • Phone: 562-459-3311
  • Fax:
Mailing address:
  • Phone: 310-872-8681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. SIRISH MAKAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-872-8681