Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A146471 | CA |
N | 208000000X | Pediatrician | A146471 | CA |
NPI | 1043755754 |
---|---|
Provider Name | Mona M Liu |
First Address | San Jose, CA 95119-1130 |
Second Address | San Jose, CA 95119-1130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2017 |
Last Update Date | 20/12/2021 |