Provider Demographics
NPI:1861562837
Name:LIU, VIVIAN C (DDS)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:C
Last Name:LIU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17705 HALE AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4345
Mailing Address - Country:US
Mailing Address - Phone:408-779-4012
Mailing Address - Fax:408-779-3445
Practice Address - Street 1:17705 HALE AVE STE B3
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4345
Practice Address - Country:US
Practice Address - Phone:408-779-4012
Practice Address - Fax:408-779-3445
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist