Healthcare Provider Details

I. General information

NPI: 1790694339
Provider Name (Legal Business Name): ZHENGDAO LI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9123 CORONA AVE UNIT S2
ELMHURST NY
11373-5029
US

IV. Provider business mailing address

9115 LAMONT AVE APT 4G
ELMHURST NY
11373-2775
US

V. Phone/Fax

Practice location:
  • Phone: 917-365-8778
  • Fax:
Mailing address:
  • Phone: 917-365-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065792
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: