Healthcare Provider Details

I. General information

NPI: 1013920966
Provider Name (Legal Business Name): BERTY PANYAJINTA LIAU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 8TH AVE SUITE 202
SAN FRANCISCO CA
94118-3055
US

IV. Provider business mailing address

402 8TH AVE SUITE 202
SAN FRANCISCO CA
94118-3055
US

V. Phone/Fax

Practice location:
  • Phone: 415-751-1411
  • Fax: 415-751-3923
Mailing address:
  • Phone: 415-751-1411
  • Fax: 415-751-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG70626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: