Individual provider Active NPI

Jenny Liu, MD

  • Pediatrics Physician
  • Honolulu, HI
National Provider Identifier
1013571546
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD22312 Issued in HI
Practice address
1301 Punchbowl St
Honolulu, HI 96813-2402
Phone
(808) 691-4970
Fax
(808) 691-5075
NPI assigned
Apr 30, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD22312 HI Primary

Addresses

Primary practice location

1301 Punchbowl St
Honolulu, HI 96813-2402

Mailing address

1301 Punchbowl St
Honolulu, HI 96813-2402
Phone (808) 691-4970

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220616002932 HI Practitioner - Pediatric Medicine 3870972128 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD22312HIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Queens University Medical Group CurrentSince Oct 1, 2024 Accepting new patients
Queen Emma Clinics CurrentSince Jul 1, 2022 Accepting new patients
The Queens Medical Center CurrentSince Jul 1, 2022 Accepting new patients
The Queen'S Medical Center Current Accepting new patients

Locations

91-2301 Fort Weaver Rd
Ewa Beach, HI 96706
Phone (808) 671-8511

91-6390 Kapolei Pkwy
Ste 200
Ewa Beach, HI 96706
Phone (612) 802-2986

1301 Punchbowl St
Honolulu, HI 96813
Phone (808) 538-9011

1380 Lusitana St
Ste 913
Honolulu, HI 96813
Phone (808) 691-8521

1319 Punahou St
Ste 741
Honolulu, HI 96826

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1013571546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 PUNCHBOWL ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132402",
            "telephone_number": "808-691-4970",
            "fax_number": "808-691-5075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PUNCHBOWL ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132402",
            "telephone_number": "808-691-4970",
            "fax_number": "808-691-5075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIU",
        "first_name": "JENNY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-30",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "HI",
            "license": "MD22312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.