NPIMap

Organization Active NPI

Jung Jung Liu

Doing business as Academy Dental Center

  • Dentist
  • West Covina, CA
National Provider Identifier
1629195870
Registry record updated Jul 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
122337253 Issued in CA
Legal business name
JUNG JUNG LIU
Doing business as
Academy Dental Center
Practice address
628 North Azusa Ave
West Covina, CA 91791
Phone
(626) 966-8408
Fax
(626) 967-4557
NPI assigned
Mar 23, 2007
Last updated
Jul 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2008

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

Authorized official

Name
Dr. Stephanie Jung Liu, DDSNPI 1912023672
Title
Owner
Phone
(626) 966-8408

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 122337253 CA Primary

Addresses

Primary practice location

628 North Azusa Ave
West Covina, CA 91791

Mailing address

628 North Azusa Ave
West Covina, CA 91791
Phone (626) 966-8408

Other identifiers 1

IdentifierTypeStateIssuer
G9075801OtherCAMEDI CAL DENTI CAL

Other names 1

  • Academy Dental Center Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215388800000",
    "number": "1629195870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 NORTH AZUSA AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "91791",
            "telephone_number": "626-966-8408",
            "fax_number": "626-967-4557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 NORTH AZUSA AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "91791",
            "telephone_number": "626-966-8408",
            "fax_number": "626-967-4557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUNG JUNG LIU",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2008-07-07",
        "status": "A",
        "authorized_official_last_name": "LIU",
        "authorized_official_first_name": "STEPHANIE JUNG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-966-8408",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "122337253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI CAL DENTI CAL",
            "identifier": "G9075801",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Academy Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Covina, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; 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.