Provider Demographics
NPI:1407677081
Name:LI, JIARUI (PHD, RDN)
Entity type:Individual
Prefix:DR
First Name:JIARUI
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:PHD, RDN
Other - Prefix:DR
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, RDN
Mailing Address - Street 1:323 LYDIA LN
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:323 LYDIA LN
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-8529
Practice Address - Country:US
Practice Address - Phone:909-569-9639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86079741133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered