Provider Demographics
NPI:1467958199
Name:LIANG, YIWEN
Entity Type:Individual
Prefix:
First Name:YIWEN
Middle Name:
Last Name:LIANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 W DUSTY WREN DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8061
Mailing Address - Country:US
Mailing Address - Phone:651-447-0969
Mailing Address - Fax:
Practice Address - Street 1:7301 E 2ND ST STE 210
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5620
Practice Address - Country:US
Practice Address - Phone:480-882-4545
Practice Address - Fax:480-946-6997
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61170566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine