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General NPI Number Information
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NPI Number | 1609978055
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Entity Type | Organization
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Legal Business Name | LOS ANGELES DENTAL OFFICE
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13704 E ANAR RD
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City | LA PUENTE
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State | CA
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Zip | 91746
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Country | US
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Telephone | 626-917-3088
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Fax | 626-917-9333
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Provider Business Mailing Address
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Address Line | 13704 E ANAR RD
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City | LA PUENTE
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State | CA
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Zip | 91476
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Country | US
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Telephone | 626-917-3088
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Fax | 626-917-9333
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | XUAN LIU
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Credential | DDS PHD MS
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Telephone | 626-917-3088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 52421
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License Number State | CA
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