Healthcare Provider Details

I. General information

NPI: 1144421504
Provider Name (Legal Business Name): XINYU DANIEL LI MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 BIA ROUTE 4
FORT THOMPSON SD
57339-0200
US

IV. Provider business mailing address

PO BOX 200
FORT THOMPSON SD
57339-0200
US

V. Phone/Fax

Practice location:
  • Phone: 605-245-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number064592
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN 10258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: