Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 21833 | MA |
Y | 1223D0001X | Dental Public Health | 051291 | NY |
NPI | 1346434198 |
---|---|
Provider Name | Wen Li |
First Address | New York, NY 10013-5132 |
Second Address | New York, NY 10013-5132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2007 |
Last Update Date | 10/09/2013 |