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General NPI Number Information
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NPI Number | 1992944219
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Entity Type | Individual
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Provider Name | JINGJING LI DDS
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Gender | Female
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Dates
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Enumeration Date | 02/10/2009
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 19778 PROSPECT PL
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City | WALNUT
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State | CA
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Zip | 91789-5359
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Country | US
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Telephone | 323-365-5603
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Fax |
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Provider Business Mailing Address
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Address Line | 19778 PROSPECT PL
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City | WALNUT
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State | CA
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Zip | 91789-5359
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Country | US
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Telephone | 323-365-5603
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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 | 56851
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License Number State | CA
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