Healthcare Provider Details

I. General information

NPI: 1477014918
Provider Name (Legal Business Name): JONATHAN LEE LIANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 S VINEYARD AVE
ONTARIO CA
91761-7925
US

IV. Provider business mailing address

2295 S VINEYARD AVE STE A
ONTARIO CA
91761-7926
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 424-703-4292
  • Fax: 310-905-6417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A20938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: