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General NPI Number Information
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NPI Number | 1013391549
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Entity Type | Individual
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Provider Name | JASON Z LI DDS
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Gender | Male
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 04/25/2018
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Provider Practice Location Address
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Address Line | 6945 MYRTLE AVE
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City | GLENDALE
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State | NY
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Zip | 11385-7265
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Country | US
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Telephone | 718-821-4680
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Fax |
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Provider Business Mailing Address
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Address Line | 155 BORDEN AVE APT 21G
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-6238
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Country | US
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Telephone | 646-407-8757
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 058540
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License Number State | NY
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