Provider Demographics
NPI:1407698806
Name:LIU, ANGELA YANG
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:YANG
Last Name:LIU
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 BARLOW RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4090
Mailing Address - Country:US
Mailing Address - Phone:330-671-9468
Mailing Address - Fax:
Practice Address - Street 1:1739 BARLOW RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4090
Practice Address - Country:US
Practice Address - Phone:330-671-9468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86330180133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered