MEDICARE: DR. MARK W. 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	207RG0100X	Gastroenterology Physician	G44985	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	:	1356375059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK W. LI M.D.

Provider Business Mailing Address
First Line	:	2440 S HACIENDA BLVD STE 105
Second Line	:
City	:	HACIENDA HTS
State	:	CA
Zip	:	91745-4763
Country	:	US
Telephone Number	:	626-330-6003
Fax Number	:	626-330-8474

Provider Business Practice Location Address
First Line	:	2440 S HACIENDA BLVD STE 105
Second Line	:
City	:	HACIENDA HTS
State	:	CA
Zip	:	91745-4763
Country	:	US
Telephone Number	:	626-330-6003
Fax Number	:	626-330-8474

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	05/24/2019

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Directions to “ DR. MARK W. LI M.D.” Practice Location

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