Individual
JIM LIAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
300 MEDICAL PLZ, STE 400, LOS ANGELES, CA 90095-0001
(310) 825-5111
Mailing address
5767 W CENTURY BLVD, SUITE 400, LOS ANGELES, CA 90045-5631
(310) 825-5111
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
PA16667
CA
363AS0400X
Surgical Physician Assistant
Primary
PA16667
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA16667
—
CA
Enumeration date
07/13/2006
Last updated
07/26/2010
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