Provider Demographics
NPI:1790725364
Name:LIU, JASON Y (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:Y
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:56 LINDA ISLE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7207
Mailing Address - Country:US
Mailing Address - Phone:714-507-8101
Mailing Address - Fax:949-723-0282
Practice Address - Street 1:56 LINDA ISLE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7207
Practice Address - Country:US
Practice Address - Phone:714-507-8101
Practice Address - Fax:949-723-0282
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG481802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50963Medicare UPIN
CAWG48180AMedicare ID - Type Unspecified