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General NPI Number Information
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NPI Number | 1417186925
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Entity Type | Individual
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Provider Name | DR. CHUAN LI
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Gender | Male
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 5675 N FRONT ST STE 50
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City | PHILADELPHIA
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State | PA
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Zip | 19120
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Country | US
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Telephone | 617-372-3902
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Fax |
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Provider Business Mailing Address
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Address Line | 2300N MAYFAIR RD 920
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City | WAUWATOSA
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State | WI
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Zip | 53226-1519
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Country | US
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Telephone | 414-257-1230
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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 | 6488-15
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License Number State | WI
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