1811220510 NPI number — MRS. XIAODAN LI

Table of content: MRS. XIAODAN LI (NPI 1811220510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811220510 NPI number — MRS. XIAODAN LI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LI
Provider First Name:
XIAODAN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANTO
Provider Other First Name:
YOSHIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.AC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811220510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20445 PACIFICA DR
Provider Second Line Business Mailing Address:
STE A1
Provider Business Mailing Address City Name:
CUPERTINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95014-3017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-766-8718
Provider Business Mailing Address Fax Number:
408-996-7358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20445 PACIFICA DR
Provider Second Line Business Practice Location Address:
STE A1
Provider Business Practice Location Address City Name:
CUPERTINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95014-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-766-8718
Provider Business Practice Location Address Fax Number:
408-996-7358
Provider Enumeration Date:
09/12/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC 13263 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)