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General NPI Number Information
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NPI Number | 1740503705
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Entity Type | Organization
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Legal Business Name | LEO LI MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/04/2010
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Last Update Date | 03/12/2010
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Provider Practice Location Address
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Address Line | 309 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4308
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Country | US
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Telephone | 818-475-8014
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Fax | 562-696-4238
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Provider Business Mailing Address
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Address Line | PO BOX 6359
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City | WHITTIER
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State | CA
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Zip | 90609-6359
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Country | US
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Telephone | 818-475-8014
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Fax | 562-696-4238
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEO LI
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Credential | MD
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Telephone | 818-475-8014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G82244
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License Number State | CA
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