MEDICARE: MS. HONG YING LI MD

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	207L00000X	Anesthesiology Physician	A75719	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A757194	OTHER	CA	MEDICARE NHIC
2	00A757192	OTHER	CA	MEDICARE NHIC
3	00A757193	OTHER	CA	MEDICARE NHIC

General Provider Information

NPI Number	:	1073599627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HONG YING LI MD

Provider Business Mailing Address
First Line	:	PO BOX 7096
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95267-0096
Country	:	US
Telephone Number	:	209-956-7725
Fax Number	:	209-956-7733

Provider Business Practice Location Address
First Line	:	6501 COYLE AVE
Second Line	:
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-0306
Country	:	US
Telephone Number	:	916-537-5000
Fax Number	:	916-851-2884

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	12/15/2021

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