MEDICARE: EVERGREEN HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1073401899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERGREEN HEALTH

Provider Business Mailing Address
First Line	:	719 COLORADO AVE STE 100
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94303-3913
Country	:	US
Telephone Number	:	408-571-8839
Fax Number	:

Provider Business Practice Location Address
First Line	:	719 COLORADO AVE STE 100
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94303-3913
Country	:	US
Telephone Number	:	408-571-8839
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ADAM LIU
Credential	:
Telephone Number	:	408-571-8839

Provider Enumeration Date	:	06/27/2025
Last Update Date	:	03/06/2026

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Directions to “EVERGREEN HEALTH ” Practice Location

Language	Start Address	Practice Location

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