Provider Demographics
NPI:1144490962
Name:BACH, LIAN (DO)
Entity type:Individual
Prefix:
First Name:LIAN
Middle Name:
Last Name:BACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3870
Mailing Address - Country:US
Mailing Address - Phone:714-288-3230
Mailing Address - Fax:714-744-5294
Practice Address - Street 1:2212 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-288-3230
Practice Address - Fax:714-744-5294
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A10289OtherSTATE LIC