Provider Demographics
NPI:1164839619
Name:DR. DAVID J. LISS, DPM, INC
Entity Type:Organization
Organization Name:DR. DAVID J. LISS, DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:LISS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-645-3338
Mailing Address - Street 1:9100 S SEPULVEDA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4849
Mailing Address - Country:US
Mailing Address - Phone:310-645-3338
Mailing Address - Fax:310-645-0823
Practice Address - Street 1:9100 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4814
Practice Address - Country:US
Practice Address - Phone:310-645-3338
Practice Address - Fax:310-645-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5120213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty