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General NPI Number Information
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NPI Number | 1144421504
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Entity Type | Individual
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Provider Name | XINYU DANIEL LI MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 1323 BIA ROUTE 4
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City | FORT THOMPSON
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State | SD
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Zip | 57339-0200
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Country | US
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Telephone | 605-245-1500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 200
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City | FORT THOMPSON
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State | SD
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Zip | 57339-0200
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Country | US
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Telephone |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 064592
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | TRN 10258
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License Number State | FL
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