Active NPI
Michael Liu
- General Practice Dentistry
- Irvine, CA
National Provider Identifier
1104340017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 101764
- Practice address
- 4200 Trabuco Rd Ste 130
Irvine, CA 92620-3622 - Phone
- (949) 551-4737
- NPI assigned
- Aug 1, 2017
- Last updated
- Sep 2, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 101764 | CA | Primary |
Addresses
Primary practice location
4200 Trabuco Rd Ste 130
Irvine, CA 92620-3622
Mailing address
12365 Fairbanks Dr
Tustin, CA 92782-1145
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180820002800 | CA | Order and Referring Only - Dentist | 7618226903 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101764 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charng Shing Jean Dental Corporation | General Practice | Past | Accepting new patients |
| Wang and Jean DMD Inc | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Santa Ana, CA
- NPI 1093418543
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1504310400000",
"number": "1104340017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12365 FAIRBANKS DR",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927821145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 TRABUCO RD STE 130",
"city": "IRVINE",
"state": "CA",
"postal_code": "926203622",
"telephone_number": "949-551-4737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIU",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-01",
"last_updated": "2017-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "101764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.