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General NPI Number Information
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NPI Number | 1063175230
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Entity Type | Individual
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Provider Name | ELLEN JIACHEN LIANG DDS
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Gender | Female
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Dates
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Enumeration Date | 10/14/2021
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 7181 N HUALAPAI WAY STE 105
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City | LAS VEGAS
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State | NV
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Zip | 89166-1116
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Country | US
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Telephone | 702-703-8609
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Fax |
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Provider Business Mailing Address
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Address Line | 9950 W TROPICANA AVE APT 1052
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City | LAS VEGAS
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State | NV
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Zip | 89147-8543
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Country | US
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Telephone | 415-815-6218
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7568
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License Number State | NV
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