Healthcare Provider Details

I. General information

NPI: 1053024141
Provider Name (Legal Business Name): EMMA H LIU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 SEPULVEDA BLVD STE 206
TORRANCE CA
90505-8161
US

IV. Provider business mailing address

12036 CULVER BLVD APT 6
LOS ANGELES CA
90066-7105
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-5877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS109503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: