Healthcare Provider Details

I. General information

NPI: 1609827443
Provider Name (Legal Business Name): SHWUJING JESSICA LIU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LIU LCSW

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 W OLYMPIC BLVD
LOS ANGELES CA
90015-1483
US

IV. Provider business mailing address

13768 ROSWELL AVE STE 220
CHINO CA
91710-1408
US

V. Phone/Fax

Practice location:
  • Phone: 213-553-1850
  • Fax: 213-553-1864
Mailing address:
  • Phone: 213-252-2100
  • Fax: 213-383-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: