MEDICARE: DR. TONY TIAN LIAN LI DDS, 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	208600000X	Surgery Physician	MT201468	PA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	57935	CA

General Provider Information

NPI Number	:	1972941292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONY TIAN LIAN LI DDS, MD.

Provider Business Mailing Address
First Line	:	163 N MARENGO AVE
Second Line	:	#401
City	:	PASADENA
State	:	CA
Zip	:	91101-4509
Country	:	US
Telephone Number	:	510-875-3243
Fax Number	:

Provider Business Practice Location Address
First Line	:	163 N MARENGO AVE
Second Line	:	#401
City	:	PASADENA
State	:	CA
Zip	:	91101-4509
Country	:	US
Telephone Number	:	510-875-3243
Fax Number	:

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

Provider Enumeration Date	:	06/09/2013
Last Update Date	:	09/02/2015

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