Healthcare Provider Details

I. General information

NPI: 1376473553
Provider Name (Legal Business Name): BAOLING LI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17115 MEEKLAND AVE
CHERRYLAND CA
94541-1304
US

IV. Provider business mailing address

625 CAMELLIA CT APT 2211
HAYWARD CA
94544-5555
US

V. Phone/Fax

Practice location:
  • Phone: 510-534-0341
  • Fax:
Mailing address:
  • Phone: 510-534-0341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number36002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: