Healthcare Provider Details

I. General information

NPI: 1023349669
Provider Name (Legal Business Name): XU LI MD, PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 COTTLE RD BLDG 6
SAN JOSE CA
95123-3640
US

IV. Provider business mailing address

5755 COTTLE RD BLDG 6
SAN JOSE CA
95123-3640
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-3326
  • Fax: 408-972-3328
Mailing address:
  • Phone: 408-972-3326
  • Fax: 408-972-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License NumberDRM7
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License NumberDRN36
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: