Healthcare Provider Details

I. General information

NPI: 1154034403
Provider Name (Legal Business Name): LI LIANG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 W LA VETA AVE STE 108
ORANGE CA
92868-3930
US

IV. Provider business mailing address

845 W LA VETA AVE STE 108
ORANGE CA
92868-3930
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-2600
  • Fax: 714-289-3906
Mailing address:
  • Phone: 714-639-2600
  • Fax: 714-289-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: