Healthcare Provider Details

I. General information

NPI: 1598929689
Provider Name (Legal Business Name): YONG-TONG LI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 02/02/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VAMC-PHILADELPHIA 3900 WOODLAND AVE
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

VAMC-PHILADELPHIA 3900 WOODLAND AVE
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5800
  • Fax:
Mailing address:
  • Phone: 215-823-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberMD072292L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD072292L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: