Healthcare Provider Details

I. General information

NPI: 1225121734
Provider Name (Legal Business Name): DAVID J LI DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16766 BERNARDO CENTER DR #203A
SAN DIEGO CA
92128-2545
US

IV. Provider business mailing address

16766 BERNARDO CENTER DR #203A
SAN DIEGO CA
92128-2545
US

V. Phone/Fax

Practice location:
  • Phone: 858-487-8900
  • Fax: 858-487-7308
Mailing address:
  • Phone: 858-487-8900
  • Fax: 858-487-7308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number49930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: