Active NPI
Jackie Liu
- Medical Physician Assistant
- Mililani, HI
National Provider Identifier
1386436087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- AMD-1518
- Practice address
- 100 Kahelu Ave Ste 226
Mililani, HI 96789-3962 - Phone
- (808) 621-1000
- NPI assigned
- May 19, 2025
- Last updated
- Sep 11, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | AMD-1518 | HI | Primary |
Addresses
Primary practice location
100 Kahelu Ave Ste 226
Mililani, HI 96789-3962
Mailing address
100 Kahelu Ave Ste 226
Mililani, HI 96789-3962
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AMD-1518 | HI | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Complete Dermatology | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789084800000",
"number": "1386436087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 KAHELU AVE STE 226",
"city": "MILILANI",
"state": "HI",
"postal_code": "967893962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 KAHELU AVE STE 226",
"city": "MILILANI",
"state": "HI",
"postal_code": "967893962",
"telephone_number": "808-621-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIU",
"first_name": "JACKIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-05-19",
"last_updated": "2026-09-11",
"certification_date": "2026-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physician Assistant, Medical",
"state": "HI",
"license": "AMD-1518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mililani, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.