Healthcare Provider Details

I. General information

NPI: 1033774096
Provider Name (Legal Business Name): YI LING LI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELAINE LI MD

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 OAK RD STE 270
WALNUT CREEK CA
94597-2078
US

IV. Provider business mailing address

3100 OAK RD STE 270
WALNUT CREEK CA
94597-2078
US

V. Phone/Fax

Practice location:
  • Phone: 718-839-0873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA206154
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number319683
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: