Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 12153870-1205 | UT |
NPI | 1023542495 |
---|---|
Provider Name | He Li |
First Address | Fresno, CA 93701-2302 |
Second Address | Fresno, CA 93701-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2017 |
Last Update Date | 18/11/2021 |