Healthcare Provider Details

I. General information

NPI: 1669310397
Provider Name (Legal Business Name): VANGUARD CLINICAL OVERSIGHT, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3572 NORTHRANCH WAY
GRANITE BAY CA
95661-5973
US

IV. Provider business mailing address

6644 LONETREE BLVD STE 300
ROCKLIN CA
95765-4432
US

V. Phone/Fax

Practice location:
  • Phone: 509-730-4720
  • Fax: 509-331-7054
Mailing address:
  • Phone: 509-730-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK Y LIU
Title or Position: OWNER/PRESIDENT
Credential: DO
Phone: 509-730-4720