Healthcare Provider Details

I. General information

NPI: 1841959905
Provider Name (Legal Business Name): JEFFREY THUAN LE LIEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 SHORELINE HWY
MILL VALLEY CA
94941-3678
US

IV. Provider business mailing address

230 MORNINGSIDE DR
SAN FRANCISCO CA
94132-1241
US

V. Phone/Fax

Practice location:
  • Phone: 415-380-8402
  • Fax:
Mailing address:
  • Phone: 415-519-4811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: