Healthcare Provider Details

I. General information

NPI: 1386390524
Provider Name (Legal Business Name): SALLY LIU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 10/24/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 CALIFORNIA ST
SAN FRANCISCO CA
94118-1522
US

IV. Provider business mailing address

3838 CALIFORNIA ST RM 715
SAN FRANCISCO CA
94118-1509
US

V. Phone/Fax

Practice location:
  • Phone: 415-939-1995
  • Fax:
Mailing address:
  • Phone: 415-939-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: