Provider Demographics
NPI:1215298138
Name:MERIDIAN MEDICINE LLC
Entity type:Organization
Organization Name:MERIDIAN MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LI-REN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-380-9996
Mailing Address - Street 1:33 LLOYDEN DR
Mailing Address - Street 2:
Mailing Address - City:ATHERTON
Mailing Address - State:CA
Mailing Address - Zip Code:94027-3854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1220 UNIVERSITY DR
Practice Address - Street 2:SUITE 204
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4262
Practice Address - Country:US
Practice Address - Phone:650-380-9996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13355261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center