Provider Demographics
NPI:1922102029
Name:LIAO, YUCHENG JORDAN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:YUCHENG
Middle Name:JORDAN
Last Name:LIAO
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N ROSE AVE
Mailing Address - Street 2:#480
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030
Mailing Address - Country:US
Mailing Address - Phone:805-983-6929
Mailing Address - Fax:805-983-6950
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:#480
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030
Practice Address - Country:US
Practice Address - Phone:805-983-6929
Practice Address - Fax:805-983-6950
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA497772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A49777Medicaid
F06920Medicare UPIN
A49777Medicare ID - Type Unspecified