1396733291 NPI number — DR. HUAMIN HENRY LI MD, PHD

Table of content: DR. HUAMIN HENRY LI MD, PHD (NPI 1396733291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396733291 NPI number — DR. HUAMIN HENRY LI MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LI
Provider First Name:
HUAMIN
Provider Middle Name:
HENRY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
M

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1396733291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11002 VEIRS MILL RD
Provider Second Line Business Mailing Address:
414
Provider Business Mailing Address City Name:
WHEATON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20902-2574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-962-5800
Provider Business Mailing Address Fax Number:
301-962-9585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11002 VEIRS MILL RD
Provider Second Line Business Practice Location Address:
SUITE 414
Provider Business Practice Location Address City Name:
WHEATON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20902-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-962-5800
Provider Business Practice Location Address Fax Number:
301-962-9585
Provider Enumeration Date:
10/13/2005

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: 207KA0200X , with the licence number:  D55098 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207KA0200X , with the licence number: MD34049 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 675418 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7657502 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 02-00484 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: C4540006 . This is a "CAREFIRST NCA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 233488 . This is a "KAISER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2133588 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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