Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 34350 | TX |
NPI | 1063943488 |
---|---|
Provider Name | Mindy Li |
First Address | Hacienda Heights, CA 91745-3118 |
Second Address | Carrollton, TX 75007-1532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2017 |
Last Update Date | 26/09/2018 |