Healthcare Provider Details

I. General information

NPI: 1104646066
Provider Name (Legal Business Name): MORPHO PLASTIC SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 E WALNUT ST
PASADENA CA
91101-1614
US

IV. Provider business mailing address

PO BOX 10868
BEVERLY HILLS CA
90213-3868
US

V. Phone/Fax

Practice location:
  • Phone: 310-933-9944
  • Fax: 310-382-2422
Mailing address:
  • Phone: 310-933-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PERRY LIU
Title or Position: PRESIDENT
Credential: MD
Phone: 310-919-1333