Provider Demographics
NPI:1609978055
Name:LOS ANGELES DENTAL OFFICE
Entity Type:Organization
Organization Name:LOS ANGELES DENTAL OFFICE
Other - Org Name:XUAN LIU DDS PHD DS OF SUNLI ZHARND MED CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:XUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PHD MS
Authorized Official - Phone:626-917-3088
Mailing Address - Street 1:13704 E ANAR RD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91476
Mailing Address - Country:US
Mailing Address - Phone:626-917-3088
Mailing Address - Fax:626-917-9333
Practice Address - Street 1:13704 E ANAR RD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746
Practice Address - Country:US
Practice Address - Phone:626-917-3088
Practice Address - Fax:626-917-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty