Provider Demographics
NPI:1093859944
Name:LIANG, JOHN J (LIC AP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:LIANG
Suffix:
Gender:M
Credentials:LIC AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4603
Mailing Address - Country:US
Mailing Address - Phone:407-236-7800
Mailing Address - Fax:407-236-7820
Practice Address - Street 1:628 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4603
Practice Address - Country:US
Practice Address - Phone:407-236-7800
Practice Address - Fax:407-236-7820
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP000389171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0181OtherBLUE CROSS&BLUE SHIELDS