Provider Demographics
NPI:1417448663
Name:LIU, VIVIAN TC (MD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:TC
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TZU CHI
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2020 E 28TH STREET, SUITE 104
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407
Mailing Address - Country:US
Mailing Address - Phone:612-333-0770
Mailing Address - Fax:612-359-0475
Practice Address - Street 1:2020 E 28TH STREET, SUITE 104
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407
Practice Address - Country:US
Practice Address - Phone:612-333-0770
Practice Address - Fax:612-359-0475
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29058390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program