MEDICARE: DR. JIEWEN LI DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	34.018252	OH
2	2085R0202X	Diagnostic Radiology Physician	81780	MN

General Provider Information

NPI Number	:	1003435967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIEWEN LI DO

Provider Business Mailing Address
First Line	:	2600 6TH ST SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-1702
Country	:	US
Telephone Number	:	330-243-6947
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 1/2 S AVENUE 60
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-4217
Country	:	US
Telephone Number	:	216-370-8300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2020
Last Update Date	:	02/17/2026

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Directions to “ DR. JIEWEN LI DO” Practice Location

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