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General NPI Number Information
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NPI Number | 1669534442
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Entity Type | Individual
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Provider Name | YIWEN LIU D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11103 VENICE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90034-6914
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Country | US
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Telephone | 310-559-9191
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Fax | 310-559-9797
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Provider Business Mailing Address
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Address Line | 2121 BELOIT AVE #304
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City | LOS ANGELES
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State | CA
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Zip | 90025-6263
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Country | US
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Telephone | 310-486-9989
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Fax | 310-478-3535
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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 | 46875
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License Number State | CA
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