Healthcare Provider Details

I. General information

NPI: 1225805666
Provider Name (Legal Business Name): CAROLINA CHONG LIAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 HOSPITAL DR STE 210
MOUNTAIN VIEW CA
94040-4117
US

IV. Provider business mailing address

973 UNIVERSITY AVE
LOS GATOS CA
95032-7636
US

V. Phone/Fax

Practice location:
  • Phone: 408-871-3400
  • Fax:
Mailing address:
  • Phone: 408-871-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: