Active NPI
Kofeng Liu, DDS
- Dentist
- Flushing, NY
National Provider Identifier
1871646992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 048253
- Practice address
- 3915 Main St
Suite100
Flushing, NY 11354-5431 - Phone
- (718) 353-3133
- NPI assigned
- Jan 19, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 048253 | NY | Primary |
Addresses
Primary practice location
3915 Main St
Suite100
Flushing, NY 11354-5431
Mailing address
3915 Main St
Suite100
Flushing, NY 11354-5431
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01960796 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150713002090 | NY | Order and Referring Only - Other (Physician) | 9830402346 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048253 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871646992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3915 MAIN ST",
"address_2": "SUITE100",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113545431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3915 MAIN ST",
"address_2": "SUITE100",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113545431",
"telephone_number": "718-353-3133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIU",
"first_name": "KOFENG",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "048253",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01960796",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flushing, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.