Provider Demographics
NPI:1285698829
Name:LIAO, SHIXIONG (MD)
Entity type:Individual
Prefix:DR
First Name:SHIXIONG
Middle Name:
Last Name:LIAO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 DUNKIRK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1709 DUNKIRK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4303
Practice Address - Country:US
Practice Address - Phone:843-737-7468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.172795207ZP0102X
SC24005207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2012-02070OtherMEDICAL LICENSE
SCT80141Medicaid
SC24005OtherSC MEDICAL LICENSE#
IL036.172795OtherILLINOIS MEDICAL LICENSE #
GA70136OtherMEDICAL LICENSE