1083767164 NPI number — DR. JANE LIANG O.D.

Table of content: DR. JANE LIANG O.D. (NPI 1083767164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083767164 NPI number — DR. JANE LIANG O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIANG
Provider First Name:
JANE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083767164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2115 S HACIENDA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HACIENDA HEIGHTS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91745-4243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-330-4115
Provider Business Mailing Address Fax Number:
626-330-4116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2115 S HACIENDA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACIENDA HEIGHTS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91745-4243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-330-4115
Provider Business Practice Location Address Fax Number:
626-330-4116
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  11266T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13690 . This is a "MEDICAL EYE SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 4049 . This is a "SUPERIOR VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SD0112661 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CA1266 . This is a "EYE MED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FV25028 . This is a "SPECTERA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 49807 . This is a "DAVIS VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 6263304115 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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