Healthcare Provider Details

I. General information

NPI: 1952178592
Provider Name (Legal Business Name): LIYAN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2658 SAN BRUNO AVE
SAN FRANCISCO CA
94134-1507
US

IV. Provider business mailing address

2658 SAN BRUNO AVE
SAN FRANCISCO CA
94134-1507
US

V. Phone/Fax

Practice location:
  • Phone: 415-336-7168
  • Fax:
Mailing address:
  • Phone: 415-336-7168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number810027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: