Provider Demographics
NPI:1982702056
Name:LI, MING (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MING
Middle Name:
Last Name:LI
Suffix:
Gender:F
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 1:25 N 14TH ST
Mailing Address - Street 2:SUITE 920
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6204
Mailing Address - Country:US
Mailing Address - Phone:408-993-8764
Mailing Address - Fax:408-993-8765
Practice Address - Street 1:25 N 14TH ST
Practice Address - Street 2:SUITE 920
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6204
Practice Address - Country:US
Practice Address - Phone:408-993-8764
Practice Address - Fax:408-993-8765
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66818207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A668181Medicaid
H51649Medicare UPIN
CA00A668181Medicaid
00A668180Medicare ID - Type Unspecified