Provider Demographics
NPI:1689207276
Name:LIAO, CHIA-CHEN OWEN (LIC AC)
Entity Type:Individual
Prefix:MR
First Name:CHIA-CHEN
Middle Name:OWEN
Last Name:LIAO
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:604 S FREDERICK AVE STE 407
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1284
Mailing Address - Country:US
Mailing Address - Phone:301-519-2346
Mailing Address - Fax:301-519-2346
Practice Address - Street 1:604 S FREDERICK AVE STE 407
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1284
Practice Address - Country:US
Practice Address - Phone:301-519-2346
Practice Address - Fax:301-519-2346
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01127171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist