Healthcare Provider Details

I. General information

NPI: 1699867390
Provider Name (Legal Business Name): YONGXIN LI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/23/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17075 DEVONSHIRE ST., STE 306
NORTHRIDGE CA
91325
US

IV. Provider business mailing address

17075 DEVONSHIRE ST., STE 306
NORTHRIDGE CA
91325
US

V. Phone/Fax

Practice location:
  • Phone: 818-831-3227
  • Fax: 818-831-3447
Mailing address:
  • Phone: 818-831-3227
  • Fax: 818-831-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20072
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number205204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: