Healthcare Provider Details

I. General information

NPI: 1225219041
Provider Name (Legal Business Name): RAN LI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39207 SUNDALE DR
FREMONT CA
94538-1916
US

IV. Provider business mailing address

3273 BRIONES TER
FREMONT CA
94538-3083
US

V. Phone/Fax

Practice location:
  • Phone: 510-386-7052
  • Fax: 510-651-4201
Mailing address:
  • Phone: 925-699-9194
  • Fax: 925-271-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number210143697
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number522612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: