Basic Information
| Provider Information | |||||||||
| NPI: | 1780843953 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIANG | ||||||||
| FirstName: | FEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50706 | ||||||||
| Address2: | 512 E. GUTIERREZ ST. STE. C | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931500706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059633757 | ||||||||
| FaxNumber: | 8055643332 | ||||||||
| Practice Location | |||||||||
| Address1: | 314 E CARRILLO ST | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931011499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8058864370 | ||||||||
| FaxNumber: | 8058458227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2008 | ||||||||
| LastUpdateDate: | 04/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 47048 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A124673 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1524320 | 05 | TN | MEDICAID |