Healthcare Provider Details

I. General information

NPI: 1912468802
Provider Name (Legal Business Name): JESSE LI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W DUARTE RD STE 206
ARCADIA CA
91007-7643
US

IV. Provider business mailing address

650 W DUARTE RD STE 206
ARCADIA CA
91007-7643
US

V. Phone/Fax

Practice location:
  • Phone: 626-462-9318
  • Fax:
Mailing address:
  • Phone: 626-462-9318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA177450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: