MEDICARE: PACIFIC ENDOCRINE DIABETES HEALTH CENTER, INC.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number	:	1619188497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC ENDOCRINE DIABETES HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	25 N 14TH ST STE 920
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-6216
Country	:	US
Telephone Number	:	408-993-8764
Fax Number	:	408-993-8765

Provider Business Practice Location Address
First Line	:	25 N 14TH ST STE 920
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-6216
Country	:	US
Telephone Number	:	408-993-8764
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MING LI
Credential	:	MD
Telephone Number	:	408-993-8764

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	12/12/2012

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