Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD60549052 | WA |
N | 207RC0000X | Internist - Cardiovascular Disease | MD60549052 | WA |
NPI | 1376832998 |
---|---|
Provider Name | Song Li |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2011 |
Last Update Date | 22/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1376832998 | (05) | WA |