Healthcare Provider Details

I. General information

NPI: 1891721171
Provider Name (Legal Business Name): CHIANGYUAN CHUCK LIAU M.D..
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 N BREA BLVD
BREA CA
92821-2606
US

IV. Provider business mailing address

PO BOX 18704
IRVINE CA
92623-8704
US

V. Phone/Fax

Practice location:
  • Phone: 714-529-6842
  • Fax: 714-256-1728
Mailing address:
  • Phone: 909-510-7678
  • Fax: 949-333-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA31031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: