Provider Demographics
NPI:1538187810
Name:LIAO, SHANG CHIEN (MD)
Entity type:Individual
Prefix:
First Name:SHANG
Middle Name:CHIEN
Last Name:LIAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 SAVIERS RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-1737
Mailing Address - Country:US
Mailing Address - Phone:805-483-8211
Mailing Address - Fax:805-483-2631
Practice Address - Street 1:1532 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-1737
Practice Address - Country:US
Practice Address - Phone:805-483-8211
Practice Address - Fax:805-483-2631
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 38344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A383440Medicaid
CA00A383440Medicaid
CAA038344Medicare ID - Type Unspecified