Provider Demographics
NPI:1568752582
Name:LISS, DAVID J (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:LISS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4849
Practice Address - Country:US
Practice Address - Phone:310-645-3338
Practice Address - Fax:310-645-0823
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5120213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery