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General NPI Number Information
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NPI Number | 1215298138
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Entity Type | Organization
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Legal Business Name | MERIDIAN MEDICINE LLC
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 1220 UNIVERSITY DR SUITE 204
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City | MENLO PARK
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State | CA
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Zip | 94025-4262
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Country | US
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Telephone | 650-380-9996
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Fax |
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Provider Business Mailing Address
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Address Line | 33 LLOYDEN DR
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City | ATHERTON
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State | CA
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Zip | 94027-3854
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LI-REN WEN
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Credential |
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Telephone | 650-380-9996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AC13355
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License Number State | CA
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