Individual
DR. OTTO LIAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1076 E 1ST ST STE B, TUSTIN, CA 92780-3852
(714) 838-2617
Mailing address
1076 E 1ST ST STE B, TUSTIN, CA 92780-3852
(714) 838-2617
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
A068959
CA
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
A068959
CA
2080P0201X
Pediatric Allergy/Immunology Physician
A068959
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11465065
CAQH
CA
Enumeration date
07/28/2006
Last updated
10/06/2020
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