Healthcare Provider Details

I. General information

NPI: 1497863260
Provider Name (Legal Business Name): IPING LIU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IRIS LIU DDS

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W REDONDO BEACH BLVD STE 203
GARDENA CA
90247-3226
US

IV. Provider business mailing address

1600 W REDONDO BEACH BLVD STE 203
GARDENA CA
90247-3226
US

V. Phone/Fax

Practice location:
  • Phone: 562-864-1011
  • Fax: 310-808-0198
Mailing address:
  • Phone: 562-864-1011
  • Fax: 310-808-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number29231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: