Provider Demographics
NPI:1487225264
Name:LIU, XIAOXU (DDS)
Entity Type:Individual
Prefix:
First Name:XIAOXU
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 S HOBART BLVD APT 539
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-4240
Mailing Address - Country:US
Mailing Address - Phone:310-721-8039
Mailing Address - Fax:
Practice Address - Street 1:687 S HOBART BLVD APT 539
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-4240
Practice Address - Country:US
Practice Address - Phone:310-721-8039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist