Healthcare Provider Details

I. General information

NPI: 1508494493
Provider Name (Legal Business Name): JANE LIAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-9430
  • Fax:
Mailing address:
  • Phone: 916-843-9430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA204134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: