Healthcare Provider Details

I. General information

NPI: 1508473521
Provider Name (Legal Business Name): CHIEH LI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 11/27/2021
Certification Date: 11/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 S WEST ST
TULARE CA
93274-3411
US

IV. Provider business mailing address

PO BOX 371
NORCO CA
92860-0371
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: