Individual provider Active NPI

Dennis Liu, MD

  • Family Medicine Physician
  • San Jose, CA
National Provider Identifier
1265457295
Registry record updated Nov 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G42212 Issued in CA
Practice address
2425 Samaritan Dr
San Jose, CA 95124-3908
Phone
(408) 558-2100
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X G42212 CA
Family Medicine Physician 207Q00000X G42212 CA Primary

Addresses

Primary practice location

2425 Samaritan Dr
San Jose, CA 95124-3908

Mailing address

718 University Ave Ste 211
Los Gatos, CA 95032-7608
Phone (408) 688-4692

Other identifiers 1

IdentifierTypeStateIssuer
00A422120MedicaidCA

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
I20101210000195 CA Practitioner - Anesthesiology 0648467092 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42212CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - Anesthesia, PC Anesthesiology Current Accepting new patients
Cep America - Anesthesia PC Anesthesiology CurrentSince Dec 1, 2014 Accepting new patients
Cep America - Anesthesia PC Anesthesiology CurrentSince Dec 1, 2014 Accepting new patients
G2 Anesthesia PC Anesthesiology PastSince Nov 21, 2021 Accepting new patients

Locations

2000 Mowry Ave
Fremont, CA 94538
Phone (510) 793-6653

975 S Fairmont Ave
Lodi, CA 95240
Phone (209) 339-7575

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

2105 Forest Ave
San Jose, CA 95128
Phone (408) 947-2500

2425 Samaritan Dr
San Jose, CA 95124
Phone (408) 354-2114

Organizations & group practices 4

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": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1265457295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 UNIVERSITY AVE STE 211",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950327608",
            "telephone_number": "408-688-4692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 SAMARITAN DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951243908",
            "telephone_number": "408-558-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIU",
        "first_name": "DENNIS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G42212",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G42212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A422120",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.