Provider Demographics
NPI:1982932877
Name:LIEM, DAVID J (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:LIEM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:900 RIDGECREST ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4623
Mailing Address - Country:US
Mailing Address - Phone:626-221-4952
Mailing Address - Fax:562-697-2108
Practice Address - Street 1:1390 S BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6374
Practice Address - Country:US
Practice Address - Phone:562-691-9541
Practice Address - Fax:562-697-2108
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11793T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU88051Medicare UPIN