Provider Demographics
NPI:1003346727
Name:LI, HUANAN (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:HUANAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5611 119TH AVE SE STE 1
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3799
Mailing Address - Country:US
Mailing Address - Phone:425-746-6454
Mailing Address - Fax:425-746-6458
Practice Address - Street 1:5611 119TH AVE SE STE 1
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-3799
Practice Address - Country:US
Practice Address - Phone:425-746-6454
Practice Address - Fax:425-746-6458
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK123308122300000X
WA611095451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist