Healthcare Provider Details

I. General information

NPI: 1003844432
Provider Name (Legal Business Name): TIT S LI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 W CESAR E CHAVEZ AVE
LOS ANGELES CA
90012-2130
US

IV. Provider business mailing address

6181 GLENEAGLES CIR
HUNTINGTON BEACH CA
92648
US

V. Phone/Fax

Practice location:
  • Phone: 213-613-1255
  • Fax: 213-613-1256
Mailing address:
  • Phone: 714-960-8245
  • Fax: 714-960-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA25684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: