Healthcare Provider Details

I. General information

NPI: 1033648282
Provider Name (Legal Business Name): STEVE LI MING LIU R.D.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LI MING LIU

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9503 BEVERLY BLVD
PICO RIVERA CA
90660-1808
US

IV. Provider business mailing address

9503 BEVERLY BLVD
PICO RIVERA CA
90660-1808
US

V. Phone/Fax

Practice location:
  • Phone: 626-414-7733
  • Fax:
Mailing address:
  • Phone: 626-414-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number28481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: