Healthcare Provider Details

I. General information

NPI: 1861562837
Provider Name (Legal Business Name): VIVIAN C LIU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17705 HALE AVE STE B3
MORGAN HILL CA
95037-4345
US

IV. Provider business mailing address

17705 HALE AVE STE B3
MORGAN HILL CA
95037-4345
US

V. Phone/Fax

Practice location:
  • Phone: 408-779-4012
  • Fax: 408-779-3445
Mailing address:
  • Phone: 408-779-4012
  • Fax: 408-779-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number48951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: