Healthcare Provider Details

I. General information

NPI: 1801690250
Provider Name (Legal Business Name): PEIDONG LI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14501 HINDRY AVE
HAWTHORNE CA
90250-6748
US

IV. Provider business mailing address

3431 E PARADUXX PRIVADO
ONTARIO CA
91762-7505
US

V. Phone/Fax

Practice location:
  • Phone: 310-536-0327
  • Fax:
Mailing address:
  • Phone: 909-570-7993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: