Provider Demographics
NPI:1033880646
Name:LI, JASMINE IRIS (PA-C)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:IRIS
Last Name:LI
Suffix:
Gender:F
Credentials:PA-C
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:850 W TOWN AND COUNTRY RD UNIT 368
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-5655
Mailing Address - Country:US
Mailing Address - Phone:972-854-8765
Mailing Address - Fax:
Practice Address - Street 1:17271 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3701
Practice Address - Country:US
Practice Address - Phone:972-854-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2022-07-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant