Provider Demographics
NPI:1023551462
Name:LIEW, LI LI
Entity Type:Individual
Prefix:
First Name:LI
Middle Name:LI
Last Name:LIEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19029 E MAUNA LOA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4114
Mailing Address - Country:US
Mailing Address - Phone:626-252-1666
Mailing Address - Fax:
Practice Address - Street 1:9353 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770
Practice Address - Country:US
Practice Address - Phone:626-287-2988
Practice Address - Fax:626-451-5990
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2186101YP2500X
171M00000X
CA9158101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator