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General NPI Number Information
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NPI Number | 1881792596
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Entity Type | Organization
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Legal Business Name | JEDI VENTURES, LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 3150 J ST
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City | SACRAMENTO
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State | CA
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Zip | 95816-4403
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Country | US
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Telephone | 916-444-7052
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Fax | 916-446-1145
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Provider Business Mailing Address
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Address Line | 3150 J ST
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City | SACRAMENTO
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State | CA
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Zip | 95816-4403
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Country | US
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Telephone | 916-444-7052
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Fax | 916-446-1145
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. KEITH LIANG
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Credential | M.D.
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Telephone | 916-444-7052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State | CA
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