Individual provider Active NPI

Kevin Liao, D.O.

  • Family Medicine Physician
  • Covina, CA
National Provider Identifier
1144534876
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A14967 Issued in CA
Practice address
420 W Rowland St
Covina, CA 91723-2943
Phone
(626) 331-6411
Fax
(626) 251-1559
NPI assigned
Aug 5, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 20A14967 CA Primary

Addresses

Primary practice location

420 W Rowland St
Covina, CA 91723-2943

Mailing address

PO Box 12209
San Bernardino, CA 92423-2209
Phone (909) 335-4188

Other practice location 1

3907 Prince St
Flushing, NY 11354-5357
Phone (718) 666-5670

Other practice location 2

8110 Mango Ave
Fontana, CA 92335-3603
Phone (909) 427-1303

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170801000943 CA Practitioner - Family Practice 4183862378 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Emanate Health Medical Care FoundationGroup PAC ID 9830544980, 85 clinicians

Practice addresses (Care Compare)

1115 S Sunset Ave
Suite 200
West Covina, CA 91790-3940
Phone (626) 732-8390

Hospital & facility affiliations

  • Emanate Health Inter-Community Hospital Hospital, Covina, CA, CCN 050382

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A14967CAMDFamily Medicine Physician
14967CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Healthcare Partners Affiliates Medical Group Family Medicine CurrentSince Apr 23, 2023 Accepting new patients
Emanate Health Medical Care Foundation CurrentSince Jan 1, 2024 Accepting new patients
Citrus Valley Physician Partners CurrentSince Jan 2, 2024 Accepting new patients
Pinnacle Medical Group, Inc Family Medicine CurrentSince Jul 14, 2017 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Apr 23, 2023 Accepting new patients
Emanate Health Medical Group Family Medicine Current Accepting new patients
Pinnacle Medical Group, Inc Family Medicine CurrentSince Jul 14, 2017 Accepting new patients
Emanate Health Medical Group CurrentSince Jan 2, 2024 Accepting new patients

Locations

1236 N Magnolia Ave
Anaheim, CA 92801
Phone (714) 995-1000

5957 W Ramsey St
Banning, CA 92220
Phone (951) 845-8864

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

420 W Rowland St
Covina, CA 91723
Phone (626) 331-6411

210 W San Bernardino Rd
Covina, CA 91723
Phone (626) 858-8580

8110 Mango Ave
Fontana, CA 92335
Phone (909) 427-1303

440 W Foothill Blvd
Glendora, CA 91741
Phone (626) 963-9402

10431 Lemon Ave
Ste N
Rch Cucamonga, CA 91737
Phone (909) 466-6579

1125 Via Verde
San Dimas, CA 91773
Phone (909) 592-8170

1700 N Waterman Ave
Sn Bernrdno, CA 92404
Phone (909) 883-8611

1135 S Sunset Ave
Ste 200
West Covina, CA 91790
Phone (626) 918-6655

1115 S Sunset Ave
Ste 200
West Covina, CA 91790
Phone (626) 732-8390

1115 S Sunset Ave
West Covina, CA 91790
Phone (626) 814-2434

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 8

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1144534876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12209",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924232209",
            "telephone_number": "909-335-4188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W ROWLAND ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917232943",
            "telephone_number": "626-331-6411",
            "fax_number": "626-251-1559"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3907 Prince St",
            "address_purpose": "LOCATION",
            "city": "Flushing",
            "state": "NY",
            "postal_code": "113545357",
            "country_code": "US",
            "telephone_number": "718-666-5670",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8110 Mango Ave",
            "address_purpose": "LOCATION",
            "city": "Fontana",
            "state": "CA",
            "postal_code": "923353603",
            "country_code": "US",
            "telephone_number": "909-427-1303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIAO",
        "first_name": "KEVIN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-05",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A14967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.