Provider Demographics
NPI:1962627786
Name:LIEU, PHOI VINH (LAC)
Entity Type:Individual
Prefix:
First Name:PHOI
Middle Name:VINH
Last Name:LIEU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6211
Mailing Address - Country:US
Mailing Address - Phone:203-258-0152
Mailing Address - Fax:
Practice Address - Street 1:1885 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5721
Practice Address - Country:US
Practice Address - Phone:203-258-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000305171100000X
CA9269171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist