Healthcare Provider Details

I. General information

NPI: 1104718790
Provider Name (Legal Business Name): NOAH LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12050 VENTURA BLVD STE C101
STUDIO CITY CA
91604-2639
US

IV. Provider business mailing address

2283 S ALTON WAY
DENVER CO
80231-3476
US

V. Phone/Fax

Practice location:
  • Phone: 818-296-9142
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: