Healthcare Provider Details

I. General information

NPI: 1073214987
Provider Name (Legal Business Name): LIU DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23731 EL TORO RD STE E
LAKE FOREST CA
92630-8615
US

IV. Provider business mailing address

32 BELL CHIME
IRVINE CA
92618-8804
US

V. Phone/Fax

Practice location:
  • Phone: 949-910-3551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA LIU
Title or Position: OWNER
Credential:
Phone: 949-910-3551