Provider Demographics
NPI:1023092020
Name:LIANG, WEN (MD)
Entity type:Individual
Prefix:
First Name:WEN
Middle Name:
Last Name:LIANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 777298
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-7298
Mailing Address - Country:US
Mailing Address - Phone:702-837-6368
Mailing Address - Fax:702-837-0685
Practice Address - Street 1:2621 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2895
Practice Address - Country:US
Practice Address - Phone:702-837-6368
Practice Address - Fax:702-837-0685
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8518207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019214Medicaid
NVCC1181OtherBLUE CROSS
NVG64086Medicare UPIN
NVV30570Medicare PIN