Healthcare Provider Details

I. General information

NPI: 1205357050
Provider Name (Legal Business Name): YI LI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2017
Last Update Date: 07/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

180 BROOKLINE AVE UNIT 932
BOSTON MA
02215-3928
US

V. Phone/Fax

Practice location:
  • Phone: 617-606-2636
  • Fax:
Mailing address:
  • Phone: 617-606-2636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number270583
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: