Provider Demographics
NPI:1003820770
Name:TLC ALLERGY AND ASTHMA ASSOCIATES INC
Entity Type:Organization
Organization Name:TLC ALLERGY AND ASTHMA ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-838-2617
Mailing Address - Street 1:1076 E 1ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3852
Mailing Address - Country:US
Mailing Address - Phone:714-838-2617
Mailing Address - Fax:
Practice Address - Street 1:1076 E 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3852
Practice Address - Country:US
Practice Address - Phone:714-838-2617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA068959207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty