Healthcare Provider Details

I. General information

NPI: 1790725364
Provider Name (Legal Business Name): JASON Y LIU MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 LINDA ISLE
NEWPORT BEACH CA
92660-7207
US

IV. Provider business mailing address

56 LINDA ISLE
NEWPORT BEACH CA
92660-7207
US

V. Phone/Fax

Practice location:
  • Phone: 714-507-8101
  • Fax: 949-723-0282
Mailing address:
  • Phone: 714-507-8101
  • Fax: 949-723-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG48180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: