Healthcare Provider Details

I. General information

NPI: 1093193575
Provider Name (Legal Business Name): LI CUI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 02/02/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S ATLANTIC BLVD
MONTEREY PARK CA
91754
US

IV. Provider business mailing address

1004 WEST COVINA PKWY 214
WEST COVINA CA
91790
US

V. Phone/Fax

Practice location:
  • Phone: 323-788-6538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA144883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: