Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | A068942 | CA |
NPI | 1124180302 |
---|---|
Provider Name | Feeiwen Amy Hsiao |
First Address | Lafayette, CA 94549-3746 |
Second Address | Berkeley, CA 94705-2067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 16/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A68942 | STATE LICENSE (01) | CA |