Provider Demographics
NPI:1316725252
Name:LI, ZHUOFAN
Entity type:Individual
Prefix:MR
First Name:ZHUOFAN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2347 TX-35 BUS
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382
Mailing Address - Country:US
Mailing Address - Phone:361-727-9897
Mailing Address - Fax:
Practice Address - Street 1:345 E. 24TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-998-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2025-09-15
Deactivation Date:2024-04-24
Deactivation Code:
Reactivation Date:2025-08-21
Provider Licenses
StateLicense IDTaxonomies
TX41692122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program