Provider Demographics
NPI:1528617628
Name:LI, KIE YING (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KIE YING
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:502 TORRANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3413
Mailing Address - Country:US
Mailing Address - Phone:310-316-0811
Mailing Address - Fax:
Practice Address - Street 1:502 TORRANCE BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3413
Practice Address - Country:US
Practice Address - Phone:310-316-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023978363A00000X
CA63865363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant