Healthcare Provider Details

I. General information

NPI: 1043263387
Provider Name (Legal Business Name): JAMES MICHAEL LIANG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 555191 NAVAL HOSPITAL CAMP PENDLETON
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

4319 CASANNA WAY 1704
OCEANSIDE CA
92057-7622
US

V. Phone/Fax

Practice location:
  • Phone: 760-763-1515
  • Fax:
Mailing address:
  • Phone: 760-212-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A 9278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: