Provider Demographics
NPI:1003844432
Name:LI, TIT S (MD)
Entity Type:Individual
Prefix:
First Name:TIT
Middle Name:S
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6181 GLENEAGLES CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648
Mailing Address - Country:US
Mailing Address - Phone:714-960-8245
Mailing Address - Fax:714-960-8295
Practice Address - Street 1:819 W CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2130
Practice Address - Country:US
Practice Address - Phone:213-613-1255
Practice Address - Fax:213-613-1256
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA25684208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0002450Medicaid
CAI08474Medicare UPIN
CAW6594AMedicare PIN