Healthcare Provider Details

I. General information

NPI: 1487225264
Provider Name (Legal Business Name): XIAOXU LIU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 S HOBART BLVD APT 539
LOS ANGELES CA
90005-4240
US

IV. Provider business mailing address

687 S HOBART BLVD APT 539
LOS ANGELES CA
90005-4240
US

V. Phone/Fax

Practice location:
  • Phone: 310-721-8039
  • Fax:
Mailing address:
  • Phone: 310-721-8039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number106440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: