1558924076 NPI number — DAVID YANG LI M.D.

Table of content: DAVID YANG LI M.D. (NPI 1558924076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558924076 NPI number — DAVID YANG LI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LI
Provider First Name:
DAVID
Provider Middle Name:
YANG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LI
Provider Other First Name:
YANG
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558924076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 BURGUNDY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKVILLE
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
L6J4E9
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 FRANCIS ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF RADIOLOGY
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-820-9502
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2019

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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