Provider Demographics
NPI:1356062483
Name:LIU, VINCENT (IDC)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 100104 BOX MEDICAL
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96667-0400
Mailing Address - Country:US
Mailing Address - Phone:671-343-1124
Mailing Address - Fax:
Practice Address - Street 1:USS EMORY S. LAND (AS 39)
Practice Address - Street 2:UNIT 100104 BOX MEDICAL
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96667-0400
Practice Address - Country:US
Practice Address - Phone:671-343-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program