Healthcare Provider Details

I. General information

NPI: 1477463115
Provider Name (Legal Business Name): LONG CA LI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 FOLSOM BLVD
SACRAMENTO CA
95819-4626
US

IV. Provider business mailing address

9047 BUNGALOW WAY
ELK GROVE CA
95758-1233
US

V. Phone/Fax

Practice location:
  • Phone: 916-905-6378
  • Fax: 916-672-0114
Mailing address:
  • Phone: 916-544-0046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: