Provider Demographics
NPI:1649897943
Name:LIANG, IVAN CHENG-CHI
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:CHENG-CHI
Last Name:LIANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 E OAKEY BLVD # 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1403
Mailing Address - Country:US
Mailing Address - Phone:702-686-3372
Mailing Address - Fax:
Practice Address - Street 1:7934 CAPE FLATTERY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4757
Practice Address - Country:US
Practice Address - Phone:626-674-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide