Healthcare Provider Details

I. General information

NPI: 1043962699
Provider Name (Legal Business Name): JIANGLAN LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 11/26/2025
Certification Date: 05/17/2023
Deactivation Date: 05/17/2023
Reactivation Date: 11/26/2025

III. Provider practice location address

102 EL CARMELO AVE
PALO ALTO CA
94306-2375
US

IV. Provider business mailing address

102 EL CARMELO AVE
PALO ALTO CA
94306-2375
US

V. Phone/Fax

Practice location:
  • Phone: 909-343-0208
  • Fax:
Mailing address:
  • Phone: 909-343-0208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number61687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: