Healthcare Provider Details

I. General information

NPI: 1811457955
Provider Name (Legal Business Name): JENNIFER JIAYI LIANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LN STE 411
ALEXANDRIA VA
22310-3250
US

IV. Provider business mailing address

6355 WALKER LN STE 411
ALEXANDRIA VA
22310-3250
US

V. Phone/Fax

Practice location:
  • Phone: 703-313-0373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101281116
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: