Healthcare Provider Details

I. General information

NPI: 1346623550
Provider Name (Legal Business Name): HUNG-I LIAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W LA PALMA AVE STE 709
ANAHEIM CA
92801-2814
US

IV. Provider business mailing address

PO BOX 15090
ANAHEIM CA
92803-5090
US

V. Phone/Fax

Practice location:
  • Phone: 657-657-7177
  • Fax: 714-772-2321
Mailing address:
  • Phone: 714-577-2124
  • Fax: 714-577-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.146307
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA156056
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-146307
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA156056
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036-146307
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036-146307
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA156056
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036.146307
License Number StateIL
# 9
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA156056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: