Provider Demographics
NPI:1093708174
Name:LISS, VERNA SILKY LI DON (MD)
Entity Type:Individual
Prefix:
First Name:VERNA
Middle Name:SILKY LI DON
Last Name:LISS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:30125 AGOURA RD
Mailing Address - Street 2:STE 200
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4337
Mailing Address - Country:US
Mailing Address - Phone:818-707-9603
Mailing Address - Fax:818-707-1276
Practice Address - Street 1:612 E JANSS RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5113
Practice Address - Country:US
Practice Address - Phone:805-373-0725
Practice Address - Fax:805-373-0574
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG42661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM546XMedicare PIN
C04235Medicare UPIN