Healthcare Provider Details

I. General information

NPI: 1114667094
Provider Name (Legal Business Name): JENNIFER YANG LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15503 VENTURA BLVD STE 240
ENCINO CA
91436-3162
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 818-461-8148
  • Fax: 818-461-8105
Mailing address:
  • Phone: 310-301-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA191710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: