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General NPI Number Information
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NPI Number | 1992085724
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Entity Type | Individual
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Provider Name | DR. JEAN LI
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Gender | Female
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 1212 NEW YORK AVE NW STE 430
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City | WASHINGTON
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State | DC
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Zip | 20005-3987
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Country | US
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Telephone | 202-735-0719
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Fax |
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Provider Business Mailing Address
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Address Line | 8724 SNOWHILL CT
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City | POTOMAC
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State | MD
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Zip | 20854-4411
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Country | US
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Telephone | 617-840-4323
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2901029333
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 15543
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DEN1001320
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License Number State | DC
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