Healthcare Provider Details

I. General information

NPI: 1659295400
Provider Name (Legal Business Name): BRUCE GUOJING LI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E 71ST ST APT 3C
NEW YORK NY
10021-4715
US

IV. Provider business mailing address

303 E 71ST ST APT 3C
NEW YORK NY
10021-4715
US

V. Phone/Fax

Practice location:
  • Phone: 519-878-9171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number340419-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: