Provider Demographics
NPI:1629043443
Name:LIAO, PUI-KAN (MB BS)
Entity Type:Individual
Prefix:DR
First Name:PUI-KAN
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:MB BS
Other - Prefix:MRS
Other - First Name:PUI-KAN
Other - Middle Name:
Other - Last Name:KAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-0061
Mailing Address - Country:US
Mailing Address - Phone:908-656-2827
Mailing Address - Fax:908-790-9551
Practice Address - Street 1:3 HIGH OAKS DR
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1621
Practice Address - Country:US
Practice Address - Phone:908-656-2827
Practice Address - Fax:908-790-9551
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2016-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05290500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA052905OtherNJ LICENSE
NJ4044801Medicaid
NJ673674C53Medicare PIN
NJE86686Medicare UPIN
NJLI673674Medicare ID - Type Unspecified