Healthcare Provider Details

I. General information

NPI: 1023990199
Provider Name (Legal Business Name): JIN LI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 EYE ST
BAKERSFIELD CA
93301-5208
US

IV. Provider business mailing address

1707 EYE ST # 100
BAKERSFIELD CA
93301-5208
US

V. Phone/Fax

Practice location:
  • Phone: 661-310-3688
  • Fax:
Mailing address:
  • Phone: 661-310-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: