Provider Demographics
NPI:1528194255
Name:LIAO, WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILSON
Middle Name:
Last Name:LIAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2616
Mailing Address - Country:US
Mailing Address - Phone:415-476-4701
Mailing Address - Fax:
Practice Address - Street 1:515 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2616
Practice Address - Country:US
Practice Address - Phone:415-476-4701
Practice Address - Fax:415-502-4126
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89988207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology