Basic Information
| Provider Information | |||||||||
| NPI: | 1023551462 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIEW | ||||||||
| FirstName: | LI | ||||||||
| MiddleName: | LI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19029 E MAUNA LOA AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917404114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262521666 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9353 VALLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | ROSEMEAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262872988 | ||||||||
| FaxNumber: | 6264515990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2016 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2186 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YP2500X | 9158 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.