MEDICARE: XIAOLIN 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	171W00000X	Contractor	NA	CA

General Provider Information

NPI Number	:	1467095943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIAOLIN LI

Provider Business Mailing Address
First Line	:	8338 ENTREKEN WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-4404
Country	:	US
Telephone Number	:	858-382-5960
Fax Number	:

Provider Business Practice Location Address
First Line	:	77840 FLORA RD
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-4109
Country	:	US
Telephone Number	:	760-200-8777
Fax Number	:

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

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	10/28/2019

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Directions to “ XIAOLIN LI ” Practice Location

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