Healthcare Provider Details

I. General information

NPI: 1407698806
Provider Name (Legal Business Name): ANGELA YANG LIU
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 BARLOW RD
HUDSON OH
44236-4090
US

IV. Provider business mailing address

1739 BARLOW RD
HUDSON OH
44236-4090
US

V. Phone/Fax

Practice location:
  • Phone: 330-671-9468
  • Fax:
Mailing address:
  • Phone: 330-671-9468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86330180
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: