Provider Demographics
NPI:1487759031
Name:PANG, JOCELYN LIAO
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:LIAO
Last Name:PANG
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JOCELYN
Other - Middle Name:
Other - Last Name:LIAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1100 PARK PL
Mailing Address - Street 2:STE 10
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1599
Mailing Address - Country:US
Mailing Address - Phone:650-212-2338
Mailing Address - Fax:650-268-8639
Practice Address - Street 1:1100 PARK PL
Practice Address - Street 2:STE 10
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1599
Practice Address - Country:US
Practice Address - Phone:650-212-2338
Practice Address - Fax:650-268-8639
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12484T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist