Healthcare Provider Details

I. General information

NPI: 1376832998
Provider Name (Legal Business Name): SONG LI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11970 N CENTRAL EXPY STE 550
DALLAS TX
75243-3958
US

IV. Provider business mailing address

11970 N CENTRAL EXPY STE 550
DALLAS TX
75243-3958
US

V. Phone/Fax

Practice location:
  • Phone: 972-940-9520
  • Fax: 972-940-9535
Mailing address:
  • Phone: 972-940-9520
  • Fax: 972-940-9535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberU3418
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: