Healthcare Provider Details

I. General information

NPI: 1932605680
Provider Name (Legal Business Name): LIANG LIAO PH.D., MBA, M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18420 102ND AVE NE APT 322
BOTHELL WA
98011-3524
US

IV. Provider business mailing address

18420 102ND AVE NE APT 322
BOTHELL WA
98011-3524
US

V. Phone/Fax

Practice location:
  • Phone: 714-624-6478
  • Fax:
Mailing address:
  • Phone: 714-624-6478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number29861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: