Healthcare Provider Details

I. General information

NPI: 1780005504
Provider Name (Legal Business Name): LI LI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

427 WASHINGTON ST APT 5
BROOKLINE MA
02446-6129
US

V. Phone/Fax

Practice location:
  • Phone: 801-550-5529
  • Fax:
Mailing address:
  • Phone: 801-550-5529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTRN#15716
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number270406
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: