Healthcare Provider Details

I. General information

NPI: 1467807123
Provider Name (Legal Business Name): NINGKUN LI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 FULTON AVE RM 208
BRONX NY
10456-3402
US

IV. Provider business mailing address

1276 FULTON AVE RM 208
BRONX NY
10456-3402
US

V. Phone/Fax

Practice location:
  • Phone: 718-901-8918
  • Fax: 718-901-8918
Mailing address:
  • Phone: 17189018918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number059182
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number059182
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: