Provider Demographics
NPI:1174045017
Name:LIAO, JINGYUAN
Entity Type:Individual
Prefix:
First Name:JINGYUAN
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-1555
Mailing Address - Country:US
Mailing Address - Phone:909-296-0049
Mailing Address - Fax:909-296-0049
Practice Address - Street 1:2540 CHARLESTON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-2508
Practice Address - Country:US
Practice Address - Phone:510-531-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program