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General NPI Number Information
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NPI Number | 1730979592
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Entity Type | Organization
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Legal Business Name | JINGYUAN LI DDS INC
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 212 S ATLANTIC BLVD STE 103
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City | LOS ANGELES
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State | CA
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Zip | 90022-1776
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Country | US
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Telephone | 323-722-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 212 S ATLANTIC BLVD STE 103
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City | LOS ANGELES
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State | CA
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Zip | 90022-1776
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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 | OWNER
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Name | JINGYUAN LI
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Credential |
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Telephone | 323-722-6600
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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 |
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License Number State |
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