Provider Demographics
NPI:1568058501
Name:LIAO, MENGDAN (LAC)
Entity Type:Individual
Prefix:
First Name:MENGDAN
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 PEPPERWOOD ST APT475
Mailing Address - Street 2:
Mailing Address - City:FARMER BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234
Mailing Address - Country:US
Mailing Address - Phone:281-229-4971
Mailing Address - Fax:
Practice Address - Street 1:1320 W WALNUT HILL LN
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038
Practice Address - Country:US
Practice Address - Phone:972-444-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01837171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist