Provider Demographics
NPI:1588988224
Name:LI, GUODONG (MD & PHD)
Entity type:Individual
Prefix:DR
First Name:GUODONG
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD & PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S HAMEL DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2807
Mailing Address - Country:US
Mailing Address - Phone:310-279-0711
Mailing Address - Fax:310-745-0393
Practice Address - Street 1:130 S HAMEL DR.
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-279-0711
Practice Address - Fax:310-745-0393
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122667207L00000X, 208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine