Healthcare Provider Details

I. General information

NPI: 1912141334
Provider Name (Legal Business Name): CONRAD LIANG M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE MOB #1, BASEMENT
FONTANA CA
92335-6720
US

IV. Provider business mailing address

9961 SIERRA AVE MOB #1, BASEMENT
FONTANA CA
92335-6720
US

V. Phone/Fax

Practice location:
  • Phone: 866-454-3485
  • Fax: 909-427-4570
Mailing address:
  • Phone: 866-454-3485
  • Fax: 909-427-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberA125044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: