Provider Demographics
NPI:1467909564
Name:JEONG, AMY LIU (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LIU
Last Name:JEONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 HOAG DR BLDG 31
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4162
Mailing Address - Country:US
Mailing Address - Phone:949-764-8258
Mailing Address - Fax:
Practice Address - Street 1:1 HOAG DR BLDG 31
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-8258
Practice Address - Fax:949-764-1493
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY020178363A00000X
CA61356363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant