MEDICARE: CHI-ING LI D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019017933	IL

General Provider Information

NPI Number	:	1366431371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHI-ING LI D.D.S.

Provider Business Mailing Address
First Line	:	1920 S LOUIE PKWY
Second Line	:	CHICAGO
City	:	CHICAGO
State	:	IL
Zip	:	60616-5011
Country	:	US
Telephone Number	:	312-225-6808
Fax Number	:

Provider Business Practice Location Address
First Line	:	746 W 79TH ST
Second Line	:	CHICAGO
City	:	CHICAGO
State	:	IL
Zip	:	60620-2424
Country	:	US
Telephone Number	:	773-488-5282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	10/09/2008

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