MEDICARE: CHI-ING LI

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	122300000X	Dentist

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	:	1366616815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHI-ING LI

Provider Business Mailing Address
First Line	:	746 W 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-2424
Country	:	US
Telephone Number	:	773-488-5282
Fax Number	:

Provider Business Practice Location Address
First Line	:	746 W 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-2424
Country	:	US
Telephone Number	:	773-488-5282
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	CHI-ING LI
Credential	:	D.D.S.
Telephone Number	:	773-488-5282

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	10/09/2008

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Directions to “CHI-ING LI ” Practice Location

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