Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 28481 | CA |
NPI | 1033648282 |
---|---|
Provider Name | Steve Li Ming Liu |
First Address | Pico Rivera, CA 90660-1808 |
Second Address | Pico Rivera, CA 90660-1808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2017 |
Last Update Date | 09/06/2017 |