Healthcare Provider Details

I. General information

NPI: 1275520819
Provider Name (Legal Business Name): MICHELLE L LI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 CALIFORNIA ST RM 616
SAN FRANCISCO CA
94118-1508
US

IV. Provider business mailing address

3838 CALIFORNIA ST RM 616
SAN FRANCISCO CA
94118-1508
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-0411
  • Fax: 415-668-6352
Mailing address:
  • Phone: 415-668-0411
  • Fax: 415-668-6352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA69093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: