MEDICARE: ERIC CONRAD LI M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	A76566	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154346468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC CONRAD LI M.D.

Provider Business Mailing Address
First Line	:	5767 WEST CENTURY
Second Line	:	SUITE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5655
Country	:	US
Telephone Number	:	310-301-8709
Fax Number	:

Provider Business Practice Location Address
First Line	:	760 WESTWOOD PLAZA
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-8353
Country	:	US
Telephone Number	:	310-825-9989
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	12/10/2008

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