Individual provider Active NPI

Jia-Kae Joseph Liou, D.D.S.

  • General Practice Dentistry
  • Thousand Oaks, CA
National Provider Identifier
1447574413
Registry record updated Aug 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
48638 Issued in CA
Practice address
2238 Shady Brook Dr
Thousand Oaks, CA 91362-1342
Phone
(805) 558-4397
NPI assigned
Mar 19, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 48638 CA Primary

Addresses

Primary practice location

2238 Shady Brook Dr
Thousand Oaks, CA 91362-1342

Mailing address

2238 Shady Brook Dr
Thousand Oaks, CA 91362-1342
Phone (805) 558-4397

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
I20191210002225 CA Practitioner - Dentist 7012340748 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
48638CAMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fulbright Dental Group, PC General Practice CurrentSince Sep 14, 2019 Accepting new patients
Lumina Healthcare, LLC General Practice PastSince Oct 23, 2022 Accepting new patients

Locations

5220 Pacific Concourse Dr
Ste 120
Los Angeles, CA 90045
Phone (310) 228-0396

1801 W Olympic Blvd
#1738
Pasadena, CA 91199

Interoperability endpoints

  • Direct secure messaging: jliou@direct.westerndental.com

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": "1268956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377561600000",
    "number": "1447574413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2238 SHADY BROOK DR",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913621342",
            "telephone_number": "805-558-4397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2238 SHADY BROOK DR",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913621342",
            "telephone_number": "805-558-4397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIOU",
        "first_name": "JIA-KAE",
        "middle_name": "JOSEPH",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-19",
        "last_updated": "2013-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "48638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thousand Oaks, CA

Sources for this page

Verify at the official NPI Registry.