MEDICARE: DOUGLAS LI MD

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	2080P0214X	Pediatric Pulmonology Physician	A108116	CA
2	208000000X	Pediatrics Physician	A108116	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	:	1932423225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS LI MD

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 15TH ST STE 1024
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1145
Country	:	US
Telephone Number	:	310-825-0867
Fax Number	:	424-259-8571

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

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	01/24/2020

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Directions to “ DOUGLAS LI MD” Practice Location

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