Provider Demographics
NPI:1962541847
Name:LIAO, DAVID SHANGKANG (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SHANGKANG
Last Name:LIAO
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1245 WILSHIRE BLVD STE 380
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4886
Mailing Address - Country:US
Mailing Address - Phone:213-483-8810
Mailing Address - Fax:213-975-9118
Practice Address - Street 1:1245 WILSHIRE BLVD STE 380
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4886
Practice Address - Country:US
Practice Address - Phone:213-483-8810
Practice Address - Fax:213-975-9118
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231238207W00000X
CAA112736207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ74423ZMedicaid
CAW3452OtherMEDICARE
MA2141892Medicaid
MA2141892Medicaid