Healthcare Provider Details

I. General information

NPI: 1306334669
Provider Name (Legal Business Name): LIANG LEE CHAO AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. LIANG-LEE CHAO

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4271 W 3RD ST
DAYTON OH
45417-1406
US

IV. Provider business mailing address

PO BOX 746071
ATLANTA GA
30374-6071
US

V. Phone/Fax

Practice location:
  • Phone: 937-971-7031
  • Fax:
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberKY3012129
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.022461
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: