Provider Demographics
NPI:1902963077
Name:LIANG, SHOU DUAN
Entity Type:Individual
Prefix:DR
First Name:SHOU DUAN
Middle Name:
Last Name:LIANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 AVONDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1610
Mailing Address - Country:US
Mailing Address - Phone:626-288-6238
Mailing Address - Fax:626-280-3679
Practice Address - Street 1:423 AVONDALE AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1610
Practice Address - Country:US
Practice Address - Phone:626-288-6238
Practice Address - Fax:626-280-3679
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3633171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC3633Medicaid