Kelly Liu, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

34306TLG Issued in CA

Practice address

491 30TH St Ste 201
Oakland, CA 94609-3235

Phone

(510) 836-2122

Fax

(510) 836-3773

NPI assigned

Jul 31, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1215581947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "491 30TH ST STE 201",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093235",
            "telephone_number": "510-836-2122",
            "fax_number": "510-836-3773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "491 30TH ST STE 201",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093235",
            "telephone_number": "510-836-2122",
            "fax_number": "510-836-3773"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4150 Clement St # 112-A",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941211563",
            "country_code": "US",
            "telephone_number": "415-750-2208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIU",
        "first_name": "KELLY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-31",
        "last_updated": "2022-02-01",
        "certification_date": "2021-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34306TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• George Boya Liu, PHARMD
• Grace Liu, MA
• Jessie Liu, MD
• Jing Y Liu, RD
• Joy Chang Liu
• Lucy H Liu
• Mengyao Liu
• Nancy Liu, PSY.D.
• Peter Liu, DPT
• Rui Qiong Liu, L.AC.,O.M.D

• Optometrist in Oakland, CA
• Providers in Oakland, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.