Provider Demographics
NPI:1255590725
Name:LIAO, EN-EN HUANG (AC)
Entity type:Individual
Prefix:
First Name:EN-EN
Middle Name:HUANG
Last Name:LIAO
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 E DYER RD STE 311
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5740
Mailing Address - Country:US
Mailing Address - Phone:949-863-0022
Mailing Address - Fax:
Practice Address - Street 1:29229 CANWOOD ST STE 205
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1515
Practice Address - Country:US
Practice Address - Phone:310-649-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1228171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC1228OtherLICENSE