Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A82162 | CA |
N | 111NI0900X | Internist | A82162 | CA |
N | 207RG0100X | Gastroenterologist | 2008-00985 | NC |
Y | 207RG0100X | Gastroenterologist | A82162 | CA |
NPI | 1043348618 |
---|---|
Provider Name | Jesse Liu |
First Address | San Francisco, CA 94109-4587 |
Second Address | San Francisco, CA 94109-4587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 12/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I22541 | (02) | CA |