Provider Demographics
NPI:1902932569
Name:LI, JI (DDS)
Entity Type:Individual
Prefix:DR
First Name:JI
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 TAMAYO ST
Mailing Address - Street 2:#37
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3374
Mailing Address - Country:US
Mailing Address - Phone:415-359-3470
Mailing Address - Fax:
Practice Address - Street 1:388 9TH ST
Practice Address - Street 2:#210
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4287
Practice Address - Country:US
Practice Address - Phone:510-893-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice