Provider Demographics
NPI:1821178823
Name:LIU, JENNIFER NG (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NG
Last Name:LIU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 E SOUTH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4579
Mailing Address - Country:US
Mailing Address - Phone:562-531-2020
Mailing Address - Fax:
Practice Address - Street 1:3300 E SOUTH ST STE 105
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90805-4579
Practice Address - Country:US
Practice Address - Phone:562-531-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 11084 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0110840Medicaid