Individual provider Active NPI

John T Liu, MD

  • Internal Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1881734465
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A69994 Issued in CA
Practice address
1245 Wilshire Blvd
Ste 914
Los Angeles, CA 90017-4810
Phone
(213) 484-8474
Fax
(213) 484-9054
NPI assigned
Feb 6, 2007
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A69994 CA Primary

Addresses

Primary practice location

1245 Wilshire Blvd
Ste 914
Los Angeles, CA 90017-4810

Mailing address

PO Box 241699
Los Angeles, CA 90024-9499
Phone (213) 484-8474

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070607000733 CA Practitioner - Internal Medicine 8426156894 Practice locations: Los Angeles, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Southern California Keck School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1245 Wilshire Blvd
Suite 914
Los Angeles, CA 90017-4809
Phone (714) 505-9041

1245 Wilshire Blvd
Suite 914
Los Angeles, CA 90017-4810

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A69994CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital, L.P. Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1881734465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 241699",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900249499",
            "telephone_number": "213-484-8474",
            "fax_number": "213-484-9054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 WILSHIRE BLVD",
            "address_2": "STE 914",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900174810",
            "telephone_number": "213-484-8474",
            "fax_number": "213-484-9054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIU",
        "first_name": "JOHN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A69994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.