Healthcare Provider Details

I. General information

NPI: 1760973473
Provider Name (Legal Business Name): JIANGZHENJUN LIAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 100TH ST SW
LAKEWOOD WA
98499-2710
US

IV. Provider business mailing address

4120 BROOKLYN AVE NE APT 407
SEATTLE WA
98105-6230
US

V. Phone/Fax

Practice location:
  • Phone: 206-930-0569
  • Fax:
Mailing address:
  • Phone: 206-317-9517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: