Healthcare Provider Details

I. General information

NPI: 1871850818
Provider Name (Legal Business Name): LI LLG DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HUNTINGTON DR STE. 520
ARCADIA CA
91007-3462
US

IV. Provider business mailing address

301 W HUNTINGTON DR STE. 520
ARCADIA CA
91007-3462
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-8530
  • Fax: 626-445-8540
Mailing address:
  • Phone: 626-445-8530
  • Fax: 626-445-8540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID Z LI
Title or Position: OWNER
Credential: D.M.D.
Phone: 626-445-8530