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General NPI Number Information
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NPI Number | 1114667094
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Entity Type | Individual
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Provider Name | JENNIFER YANG LIU
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Gender | Female
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 200 MEDICAL PLAZA SUITE 450
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City | LOS ANGELES
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State | CA
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Zip | 90095-0001
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Country | US
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Telephone | 310-825-6911
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Fax |
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Provider Business Mailing Address
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Address Line | 10833 LE CONTE AVE, 52-121 CHS
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City | LOS ANGELES
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State | CA
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Zip | 90095-3075
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A191710
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License Number State | CA
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