Provider Demographics
NPI:1639124514
Name:LIANG, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:LIANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4153 E LIVE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5828
Mailing Address - Country:US
Mailing Address - Phone:626-628-0808
Mailing Address - Fax:626-628-0816
Practice Address - Street 1:900 S 1ST AVE
Practice Address - Street 2:STE G
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3919
Practice Address - Country:US
Practice Address - Phone:626-628-0808
Practice Address - Fax:626-628-0809
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAO583YOtherMEDICARE PTAN
CAI35748Medicare UPIN
CAA86197Medicare PIN