Healthcare Provider Details

I. General information

NPI: 1891344966
Provider Name (Legal Business Name): JESSICA KAI-YI LIU MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11046 MAIN ST
EL MONTE CA
91731-2617
US

IV. Provider business mailing address

11046 MAIN ST
EL MONTE CA
91731-2617
US

V. Phone/Fax

Practice location:
  • Phone: 562-708-3406
  • Fax:
Mailing address:
  • Phone: 562-708-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: