Healthcare Provider Details

I. General information

NPI: 1215709233
Provider Name (Legal Business Name): JIALING LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10449 KLINGERMAN ST
SOUTH EL MONTE CA
91733-2149
US

IV. Provider business mailing address

10449 KLINGERMAN ST
SOUTH EL MONTE CA
91733-2149
US

V. Phone/Fax

Practice location:
  • Phone: 626-283-7496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95021991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: