Provider Demographics
NPI:1164862348
Name:LIU, JUNGYI ALEXIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUNGYI
Middle Name:ALEXIS
Last Name:LIU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JUNG-YI
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7353 ELLENA W
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8356
Mailing Address - Country:US
Mailing Address - Phone:210-596-2506
Mailing Address - Fax:
Practice Address - Street 1:PRINCE HALL ROOM 3301 11092 ANDERSON STREET
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-0001
Practice Address - Country:US
Practice Address - Phone:905-588-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX303391223P0221X
CA1085651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry