Provider Demographics
NPI:1073288858
Name:LI, WHITTY
Entity Type:Individual
Prefix:
First Name:WHITTY
Middle Name:
Last Name:LI
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 1:2300 FAIRVIEW RD APT V204
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6448
Mailing Address - Country:US
Mailing Address - Phone:949-812-1487
Mailing Address - Fax:
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 2200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2476
Practice Address - Country:US
Practice Address - Phone:323-264-7600
Practice Address - Fax:323-261-8027
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant