Healthcare Provider Details

I. General information

NPI: 1376965954
Provider Name (Legal Business Name): CHELSEA LIU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WESTCLIFF DR STE 305
NEWPORT BEACH CA
92660-5553
US

IV. Provider business mailing address

2001 WESTCLIFF DR STE 305
NEWPORT BEACH CA
92660-5553
US

V. Phone/Fax

Practice location:
  • Phone: 949-734-0126
  • Fax:
Mailing address:
  • Phone: 949-734-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: