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General NPI Number Information
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NPI Number | 1417761925
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Entity Type | Individual
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Provider Name | YIJIN LIU
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Gender | Male
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 520 E MANCHESTER AVE
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City | LOS ANGELES
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State | CA
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Zip | 90003-3525
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Country | US
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Telephone | 323-753-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 301 LODESTAR
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City | TUSTIN
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State | CA
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Zip | 92782-3756
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 111880
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License Number State | CA
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