Healthcare Provider Details

I. General information

NPI: 1174086474
Provider Name (Legal Business Name): JANE Y LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STANYAN ST
SAN FRANCISCO CA
94117-1019
US

IV. Provider business mailing address

450 STANYAN ST
SAN FRANCISCO CA
94117-1019
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-4024
  • Fax: 600-200-1431
Mailing address:
  • Phone: 415-750-4024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: