Individual provider Active NPI

Jason Kien Liu, D.D.S.

  • General Practice Dentistry
  • Brooklyn, NY
National Provider Identifier
1043467202
Registry record updated Aug 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0541121 Issued in NY
Practice address
1087 Flushing Ave Apt 313
Brooklyn, NY 11237-1811
Phone
(917) 566-1297
Fax
(718) 417-1742
NPI assigned
Aug 19, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 19, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0541121 NY Primary

Addresses

Primary practice location

1087 Flushing Ave Apt 313
Brooklyn, NY 11237-1811

Mailing address

1087 Flushing Ave Apt 313
Brooklyn, NY 11237-1811
Phone (917) 566-1297

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200103001666 CA Practitioner - Dentist 7911215975 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0541121NYMDGeneral Practice Dentistry
58007CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
San Diego American Indian Health Center General Practice CurrentSince Nov 8, 2019 Accepting new patients

Locations

2630 1st Ave
San Diego, CA 92103
Phone (619) 234-2158

2602 1st Ave
Ste 105
San Diego, CA 92103

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IFGCCD
  • Direct secure messaging: jliu713083@direct.ochin.org

Organizations & group practices 1

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": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219104000000",
    "number": "1043467202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1087 FLUSHING AVE APT 313",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112371811",
            "telephone_number": "917-566-1297",
            "fax_number": "718-417-1742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1087 FLUSHING AVE APT 313",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112371811",
            "telephone_number": "917-566-1297",
            "fax_number": "718-417-1742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIU",
        "first_name": "JASON",
        "middle_name": "KIEN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-19",
        "last_updated": "2008-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "0541121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.