Provider Demographics
NPI:1912909698
Name:DOAN, LIEN GIAO (MD)
Entity Type:Individual
Prefix:
First Name:LIEN
Middle Name:GIAO
Last Name:DOAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 W ORANGETHORPE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4209
Mailing Address - Country:US
Mailing Address - Phone:714-871-2850
Mailing Address - Fax:714-871-4380
Practice Address - Street 1:2605 W ORANGETHORPE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4209
Practice Address - Country:US
Practice Address - Phone:714-871-2850
Practice Address - Fax:714-871-4380
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CAA66684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A666840Medicaid
CA00A666840Medicaid