Basic Information
Provider Information
NPI: 1558595561
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIANG
FirstName: YU
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D., PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 512185
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900510185
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1500 DUARTE RD
Address2:  
City: DUARTE
State: CA
PostalCode: 910103012
CountryCode: US
TelephoneNumber: 6262564673
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/05/2009
LastUpdateDate: 11/12/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/12/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0101XA137020CAN Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
207ZP0102XA137020CAY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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