MEDICARE: XIA 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	207Q00000X	Family Medicine Physician	A84584	CA
2	207R00000X	Internal Medicine Physician	A84584	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	:	1659467728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIA LI

Provider Business Mailing Address
First Line	:	PO BOX 1606
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-8606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 ECHO PARK AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3318
Country	:	US
Telephone Number	:	213-977-1286
Fax Number	:	213-977-1287

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	03/17/2020

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Directions to “ XIA LI ” Practice Location

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