Provider Demographics
NPI:1528109196
Name:LI, SHIAU RUNG (PA-C)
Entity type:Individual
Prefix:
First Name:SHIAU RUNG
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:5814 IPSWICH RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1808
Mailing Address - Country:US
Mailing Address - Phone:571-201-3296
Mailing Address - Fax:
Practice Address - Street 1:10724 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3106
Practice Address - Country:US
Practice Address - Phone:410-997-5944
Practice Address - Fax:410-992-0308
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2009-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0003487363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical