| Yiwen Liu, Dds, A Professional Corporation | |
|
11103 Venice Blvd Los Angeles CA 90034-6914 | |
| (310) 559-9191 | |
| (310) 559-9797 |
| Full Name | Yiwen Liu, Dds, A Professional Corporation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 11103 Venice Blvd, Los Angeles, California |
| Authorized Official Name and Position | Yiwen Liu (PRESIDENT) |
| Authorized Official Contact | 3105599191 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Yiwen Liu, Dds, A Professional Corporation 2121 Beloit Ave Apt 304 Los Angeles CA 90025-6263 Ph: (310) 486-9989 | Yiwen Liu, Dds, A Professional Corporation 11103 Venice Blvd Los Angeles CA 90034-6914 Ph: (310) 559-9191 |
| NPI Number | 1588852479 |
|---|---|
| Provider Enumeration Date | 10/05/2007 |
| Last Update Date | 10/05/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588852479 | NPI | - | NPPES |
| 46875 | Other | CA | STATE LICENSE NUMBER |
| G93826-01 | Other | CA | DENTI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 46875 (California) | Primary |
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