Provider Demographics
NPI:1023622701
Name:LIU, JIE I (CHINA)
Entity type:Individual
Prefix:MISS
First Name:JIE
Middle Name:
Last Name:LIU
Suffix:I
Gender:F
Credentials:CHINA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 QUEEN CHARLOTTE DR APT 25
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-5544
Mailing Address - Country:US
Mailing Address - Phone:408-806-8292
Mailing Address - Fax:
Practice Address - Street 1:1617 QUEEN CHARLOTTE DR APT 25
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-5544
Practice Address - Country:US
Practice Address - Phone:408-806-8292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40576225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist