Healthcare Provider Details

I. General information

NPI: 1417526740
Provider Name (Legal Business Name): LORI LI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 180TH AVE NE
BELLEVUE WA
98008-3236
US

IV. Provider business mailing address

1655 180TH AVE NE
BELLEVUE WA
98008-3236
US

V. Phone/Fax

Practice location:
  • Phone: 206-436-9708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: