Provider Demographics
NPI:1891355186
Name:LI, DAVID GUANNAN (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GUANNAN
Last Name:LI
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LANCASTER ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-1704
Mailing Address - Country:US
Mailing Address - Phone:617-722-4100
Mailing Address - Fax:
Practice Address - Street 1:30 LANCASTER ST STE 400
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1704
Practice Address - Country:US
Practice Address - Phone:617-722-4100
Practice Address - Fax:617-227-1134
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1770504599208D00000X
MA1013828207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice