Individual provider Active NPI

Jenilee Liang

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1346079472
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
35765 Issued in CA
Practice address
11540 Santa Monica Blvd Ste 202
Los Angeles, CA 90025-7905
Phone
(310) 473-5464
NPI assigned
Jul 29, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 35765 CA Primary

Addresses

Primary practice location

11540 Santa Monica Blvd Ste 202
Los Angeles, CA 90025-7905

Mailing address

13089 Hillhaven CT
Victorville, CA 92392-0575

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250819003144 CA Practitioner - Optometry 4385143072 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

11540 Santa Monica Blvd
Suite 202
Los Angeles, CA 90025-7905

13089 Hillhaven CT
Victorville, CA 92392-0575

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Carolyn Wong Optometrist CurrentSince Jul 16, 2025 Accepting new patients

Locations

11540 Santa Monica Blvd
Ste 202
Los Angeles, CA 90025
Phone (310) 473-5464

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1722211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1346079472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13089 HILLHAVEN CT",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923920575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11540 SANTA MONICA BLVD STE 202",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900257905",
            "telephone_number": "310-473-5464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIANG",
        "first_name": "JENILEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-29",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "35765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.