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General NPI Number Information
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NPI Number | 1255993754
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Entity Type | Individual
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Provider Name | CHARLES LI DDS
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Gender | Male
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Dates
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Enumeration Date | 07/03/2019
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 1101 W VALLEY BLVD
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City | ALHAMBRA
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State | CA
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Zip | 91803-2462
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Country | US
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Telephone | 626-927-8872
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 W VALLEY BLVD STE 205
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City | ALHAMBRA
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State | CA
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Zip | 91803-2472
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Country | US
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Telephone | 626-927-8872
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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 | 103934
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License Number State | CA
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