Healthcare Provider Details

I. General information

NPI: 1255719795
Provider Name (Legal Business Name): JENNIFER LIANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2015
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 GRAND AVE
OAKLAND CA
94610-4724
US

IV. Provider business mailing address

325 SHARON PARK DR # 822
MENLO PARK CA
94025-6805
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-2777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: