Healthcare Provider Details

I. General information

NPI: 1831869056
Provider Name (Legal Business Name): YANG LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2021
Last Update Date: 09/18/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 SAN PABLO AVE
SAN PABLO CA
94806-3818
US

IV. Provider business mailing address

33 SEAGULL DR
RICHMOND CA
94804-7408
US

V. Phone/Fax

Practice location:
  • Phone: 510-231-9535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95072660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: