Provider Demographics
NPI:1083769723
Name:CHEN LIVINGOOD, JULIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:CHEN LIVINGOOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:TIEU
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3551 FARQUHAR AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3551 FARQUHAR AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2003
Practice Address - Country:US
Practice Address - Phone:562-596-1664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55234122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist