MEDICARE: YINGLUAN 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	183500000X	Pharmacist	64267	CA

General Provider Information

NPI Number	:	1679946651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YINGLUAN LI

Provider Business Mailing Address
First Line	:	215 LIBERTY ST
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-6516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 IRVINE AVE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-4602
Country	:	US
Telephone Number	:	949-642-0122
Fax Number	:

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

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	01/29/2020

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Directions to “ YINGLUAN LI ” Practice Location

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