Jim Liao, PA
Physician Assistant, Surgical in Los Angeles, CA. Individual provider (NPI-1).
NPI number1023033552
StatusActive
Last updated in NPPESJul 26, 2010
Details
- NPI
- 1023033552
- Entity type
- Individual (NPI-1)
- Name
- Jim Liao
- Credential
- PA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 13, 2006
- Last updated
- Jul 26, 2010
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AS0400X | Physician Assistant, Surgical | PA16667 | CA | Yes |
| 208600000X | Surgery | PA16667 | CA |
Practice location
300 Medical PlzSte 400
Los Angeles, CA 90095-0001
Phone 310-825-5111
Mailing address
5767 W Century BlvdSuite 400
Los Angeles, CA 90045-5631
Phone 310-825-5111
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