Provider Demographics
NPI:1003144221
Name:VERNON K. LIU MD PC
Entity Type:Organization
Organization Name:VERNON K. LIU MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:K
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-576-1118
Mailing Address - Street 1:880 E 9400 S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3667
Mailing Address - Country:US
Mailing Address - Phone:801-576-1118
Mailing Address - Fax:801-576-1221
Practice Address - Street 1:880 E 9400 S
Practice Address - Street 2:SUITE 102
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3667
Practice Address - Country:US
Practice Address - Phone:801-576-1118
Practice Address - Fax:801-576-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-29
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT207R00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT110185016OtherRAILROAD MEDICARE
UT000011966Medicare PIN