Provider Demographics
NPI:1285983494
Name:HENRY K. LIAO, MD INCORPORATED
Entity type:Organization
Organization Name:HENRY K. LIAO, MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LIAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-483-8211
Mailing Address - Street 1:1532 SAVIERS ROAD
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 ROAD
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty