1710907449 NPI number — TINGAN LI LA.C

Table of content: TINGAN LI LA.C (NPI 1710907449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710907449 NPI number — TINGAN LI LA.C

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LI
Provider Other First Name:
MELINDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LA.C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710907449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4108 MOLLER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLEASANTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94566-8440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-651-7622
Provider Business Mailing Address Fax Number:
925-600-1388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39953 BALENTINE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94560-5373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-651-7622
Provider Business Practice Location Address Fax Number:
866-573-7421
Provider Enumeration Date:
07/19/2006

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:  AC7225 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 171100000-AC7225 . This is a "TAXONOMY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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