Provider Demographics
NPI:1396092854
Name:LI, XIAN (MD)
Entity type:Individual
Prefix:
First Name:XIAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 CAMBON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-3043
Mailing Address - Country:US
Mailing Address - Phone:631-375-4104
Mailing Address - Fax:
Practice Address - Street 1:101 ST. ANDREWS LANE
Practice Address - Street 2:NSLIJ-GLEN COVE HOSPITAL
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-674-7631
Practice Address - Fax:516-674-7639
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294826207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine