Healthcare Provider Details

I. General information

NPI: 1043348618
Provider Name (Legal Business Name): JESSE LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST STE 115
SAN FRANCISCO CA
94115-2374
US

IV. Provider business mailing address

2100 WEBSTER ST STE 115
SAN FRANCISCO CA
94115-2374
US

V. Phone/Fax

Practice location:
  • Phone: 415-387-8800
  • Fax: 415-387-5204
Mailing address:
  • Phone: 415-387-8800
  • Fax: 415-387-5204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA82162
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2008-00985
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA82162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: