Healthcare Provider Details

I. General information

NPI: 1710328257
Provider Name (Legal Business Name): VIVIAN LIV M.D. A MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ROSECRANS AVE SUITE 202
MANHATTAN BEACH CA
90266-2470
US

IV. Provider business mailing address

1200 ROSECRANS AVE SUITE 202
MANHATTAN BEACH CA
90266-2470
US

V. Phone/Fax

Practice location:
  • Phone: 310-335-1411
  • Fax: 310-414-5775
Mailing address:
  • Phone: 310-335-1411
  • Fax: 310-414-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA55075
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: VIVIAN LIV
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 310-335-1411