Healthcare Provider Details

I. General information

NPI: 1386269652
Provider Name (Legal Business Name): YINGCI LIU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

3500 N BROAD ST
PHILADELPHIA PA
19140-4106
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-3449
  • Fax: 215-707-2781
Mailing address:
  • Phone: 215-707-2433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDS042501
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: