Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 35.133815 | OH |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A162485. | CA |
NPI | 1447693866 |
---|---|
Provider Name | Jet Jianqing Liu |
First Address | Fremont, CA 94538-1605 |
Second Address | Fremont, CA 94536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2013 |
Last Update Date | 17/07/2019 |