Provider Demographics
NPI:1710328257
Name:VIVIAN LIV M.D. A MEDICAL CORP.
Entity Type:Organization
Organization Name:VIVIAN LIV M.D. A MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-335-1411
Mailing Address - Street 1:1200 ROSECRANS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2470
Mailing Address - Country:US
Mailing Address - Phone:310-335-1411
Mailing Address - Fax:310-414-5775
Practice Address - Street 1:1200 ROSECRANS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2470
Practice Address - Country:US
Practice Address - Phone:310-335-1411
Practice Address - Fax:310-414-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA550752080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty