Provider Demographics
NPI:1740560671
Name:LIU, VICTORIA JUI-YA (OD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JUI-YA
Last Name:LIU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:JUI-YA
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39541 GALLAUDET DR APT 2006
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4533
Mailing Address - Country:US
Mailing Address - Phone:916-216-3085
Mailing Address - Fax:
Practice Address - Street 1:39541 GALLAUDET DR APT 2006
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4533
Practice Address - Country:US
Practice Address - Phone:916-216-3085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14251TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist