=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336594027
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEN HSIANG LIU O D INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2016
-----------------------------------------------------
Last Update Date | 03/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19209 COLIMA RD STE C
-----------------------------------------------------
City | ROWLAND HEIGHTS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91748-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-374-8178
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19209 COLIMA RD STE C
-----------------------------------------------------
City | ROWLAND HEIGHTS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91748-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JEN HSIANG LIU
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 626-374-8178
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 15186
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------