Healthcare Provider Details

I. General information

NPI: 1427243559
Provider Name (Legal Business Name): LI IRIS LI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64-1032 MAMALAHOA HWY STE 204
KAMUELA HI
96743-8441
US

IV. Provider business mailing address

333 E BETHANY DR STE C100
ALLEN TX
75002-3829
US

V. Phone/Fax

Practice location:
  • Phone: 808-887-6543
  • Fax:
Mailing address:
  • Phone: 972-268-7068
  • Fax: 972-474-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP1-0027266
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN9464
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0069290
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: