=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093209280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L&L MEDICAL CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2018
-----------------------------------------------------
Last Update Date | 12/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 818 60TH ST UNIT C3
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11220-4311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-851-8928
-----------------------------------------------------
Fax | 718-851-0618
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5115 7TH AVE FL 1
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11220-2806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-851-8928
-----------------------------------------------------
Fax | 718-851-0618
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. YIDING LI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-851-8928
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 246551
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------