Provider Demographics
NPI:1841959905
Name:LIEN, JEFFREY THUAN LE
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:THUAN LE
Last Name:LIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1241
Mailing Address - Country:US
Mailing Address - Phone:415-519-4811
Mailing Address - Fax:
Practice Address - Street 1:227 SHORELINE HWY
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3678
Practice Address - Country:US
Practice Address - Phone:415-380-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist