Healthcare Provider Details

I. General information

NPI: 1568601151
Provider Name (Legal Business Name): JENNY PEI LIU, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2071 S. ALTANTIC BLVD. #F&G
MONTEREY PARK CA
91754
US

IV. Provider business mailing address

1203 S. MARGUERITA AVE. #I
ALHAMBRA CA
91803-2450
US

V. Phone/Fax

Practice location:
  • Phone: 323-260-7878
  • Fax: 323-260-7030
Mailing address:
  • Phone: 626-293-7145
  • Fax: 626-432-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number55450
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number55450
License Number StateCA

VIII. Authorized Official

Name: DR. JENNY PEI LIU
Title or Position: CEO
Credential: D.D.S.
Phone: 626-293-7145