Healthcare Provider Details

I. General information

NPI: 1346277605
Provider Name (Legal Business Name): LI POA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20911 EARL ST STE 245
TORRANCE CA
90503
US

IV. Provider business mailing address

8635 W 3RD ST STE 865W
LOS ANGELES CA
90048-6140
US

V. Phone/Fax

Practice location:
  • Phone: 310-303-5063
  • Fax: 310-371-5351
Mailing address:
  • Phone: 310-854-3566
  • Fax: 310-427-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberG76922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: