Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A030083 | CA |
NPI | 1124164009 |
---|---|
Provider Name | Benedict Schue-Schie Liao |
First Address | Monterey Park, CA 91754-1170 |
Second Address | Monterey Park, CA 91754-1170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D76525 | (02) | CA |