Healthcare Provider Details

I. General information

NPI: 1376019927
Provider Name (Legal Business Name): VICTORIA LIOU-JOHNSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7192 KALANIANAOLE HWY STE A143A #264
HONOLULU HI
96825
US

IV. Provider business mailing address

7192 KALANIANAOLE HWY STE A143A #264
HONOLULU HI
96825
US

V. Phone/Fax

Practice location:
  • Phone: 650-434-2641
  • Fax:
Mailing address:
  • Phone: 650-434-2641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1759
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1759
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY005022
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: