Provider Demographics
NPI:1699010330
Name:LIAO, JINGYI (LAC)
Entity Type:Individual
Prefix:
First Name:JINGYI
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 1:10 CONGRESS ST STE 310
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3084
Mailing Address - Country:US
Mailing Address - Phone:626-578-9911
Mailing Address - Fax:626-626-7978
Practice Address - Street 1:10 CONGRESS ST STE 310
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3084
Practice Address - Country:US
Practice Address - Phone:626-578-9911
Practice Address - Fax:626-626-7978
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14754171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist