Provider Demographics
NPI:1770594616
Name:LIAN, THOMAS C (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:LIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9268
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-4268
Mailing Address - Country:US
Mailing Address - Phone:619-220-8114
Mailing Address - Fax:801-253-9831
Practice Address - Street 1:4077 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2105
Practice Address - Country:US
Practice Address - Phone:619-220-8114
Practice Address - Fax:801-253-9831
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG605062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE08453Medicare UPIN
CAWG60506BMedicare PIN