Healthcare Provider Details

I. General information

NPI: 1386225787
Provider Name (Legal Business Name): VIVIAN LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH ST STE 570
SANTA MONICA CA
90404-2118
US

IV. Provider business mailing address

1301 20TH ST STE 570
SANTA MONICA CA
90404-2118
US

V. Phone/Fax

Practice location:
  • Phone: 310-315-0171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA206713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: