Healthcare Provider Details

I. General information

NPI: 1093552465
Provider Name (Legal Business Name): JENNIFER MAY LIEU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 SACRAMENTO ST STE 111
SAN FRANCISCO CA
94115-2383
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-0160
  • Fax: 415-558-7036
Mailing address:
  • Phone: 415-688-0160
  • Fax: 415-558-7036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: