Johnny S Liu, DDS
Individual provider Active NPI Dentist · Alta Loma, CA
NPI 1124127956 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124127956
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 51966 (CA)
- Practice address
- 7168 Archibald Ave
Suite 200
Alta Loma, CA 91701 - Phone
- (909) 944-3120
- Fax
- (909) 483-3957
- NPI assigned
- Sep 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200407002937 | CA | Practitioner - Oral Surgery |
1052740396 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51966 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| JS Liu DDS Inc | Dentist | Current |
Accepting new patients |
| JS Lid DDS, Inc. | Current | Accepting new patients |
Locations
9791 Base Line Rd
Rancho Cucamonga, CA 91730
Phone (909) 987-8779
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 51966 | CA | Yes |
Addresses
Primary practice location
7168 Archibald Ave
Suite 200
Alta Loma, CA 91701
Mailing address
7168 Archibald Ave
Suite 200
Alta Loma, CA 91701
Phone (909) 944-3120
Other providers in Alta Loma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.