Provider Demographics
NPI:1962729160
Name:LI, CHAO (MD)
Entity type:Individual
Prefix:
First Name:CHAO
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5432 E SOUTHERN AVE STE 101B
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2772
Mailing Address - Country:US
Mailing Address - Phone:480-681-3376
Mailing Address - Fax:480-681-3372
Practice Address - Street 1:5432 E SOUTHERN AVE STE 101B
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2772
Practice Address - Country:US
Practice Address - Phone:480-681-3376
Practice Address - Fax:480-681-3372
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2022-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ52908207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
348820YMBZMedicare Oscar/Certification