Healthcare Provider Details

I. General information

NPI: 1003144221
Provider Name (Legal Business Name): VERNON K. LIU MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2009
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 E 9400 S SUITE 102
SANDY UT
84094-3667
US

IV. Provider business mailing address

880 E 9400 S SUITE 102
SANDY UT
84094-3667
US

V. Phone/Fax

Practice location:
  • Phone: 801-576-1118
  • Fax: 801-576-1221
Mailing address:
  • Phone: 801-576-1118
  • Fax: 801-576-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateUT

VIII. Authorized Official

Name: DR. VERNON K LIU
Title or Position: PRESIDENT
Credential:
Phone: 801-576-1118