Provider Demographics
NPI:1184057408
Name:LIAO, KUO HUNG (LAC)
Entity type:Individual
Prefix:MR
First Name:KUO HUNG
Middle Name:
Last Name:LIAO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 PASEO CANCUN
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2151
Mailing Address - Country:US
Mailing Address - Phone:626-616-9319
Mailing Address - Fax:
Practice Address - Street 1:9414 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2135
Practice Address - Country:US
Practice Address - Phone:626-616-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15376171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist