Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A25684 | CA |
NPI | 1003844432 |
---|---|
Provider Name | Tit S Li |
First Address | Huntington Beach, CA 92648 |
Second Address | Los Angeles, CA 90012-2130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 05/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GR0002450 | (05) | CA |
I08474 | (02) | CA |