Provider Demographics
NPI:1114038932
Name:LIANG, MIN LI DAO (L AC)
Entity Type:Individual
Prefix:MR
First Name:MIN LI DAO
Middle Name:
Last Name:LIANG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 JACKSON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4848
Mailing Address - Country:US
Mailing Address - Phone:415-982-1898
Mailing Address - Fax:415-333-7138
Practice Address - Street 1:890 JACKSON ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4848
Practice Address - Country:US
Practice Address - Phone:415-982-1898
Practice Address - Fax:415-333-7138
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6666171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0066660OtherMEDI-CAL ID NUMBER