Provider Demographics
NPI:1053950881
Name:LUO, SHIAN LI (NP)
Entity type:Individual
Prefix:
First Name:SHIAN LI
Middle Name:
Last Name:LUO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NATIONAL AVE APT 150
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2477
Mailing Address - Country:US
Mailing Address - Phone:347-301-3336
Mailing Address - Fax:
Practice Address - Street 1:1828 EL CAMINO REAL STE 405
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3115
Practice Address - Country:US
Practice Address - Phone:650-651-7175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013579363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health