Provider Demographics
NPI:1568487528
Name:TAI, LIANG-YU LAURA (DO)
Entity Type:Individual
Prefix:
First Name:LIANG-YU
Middle Name:LAURA
Last Name:TAI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1746
Mailing Address - Country:US
Mailing Address - Phone:626-307-7397
Mailing Address - Fax:626-307-1807
Practice Address - Street 1:210 N GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1746
Practice Address - Country:US
Practice Address - Phone:626-307-7397
Practice Address - Fax:626-307-1807
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A74440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX74440Medicaid
CA00AX74440Medicaid