MEDICARE: DR. CHANGRUI LIU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	41944	CA

General Provider Information

NPI Number	:	1144341454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANGRUI LIU

Provider Business Mailing Address
First Line	:	3110 GLENDON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 KANAN RD
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-3358
Country	:	US
Telephone Number	:	818-991-8881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. CHANGRUI LIU ” Practice Location

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