Provider Demographics
NPI:1083801773
Name:WEIGUO LI, LLC
Entity Type:Organization
Organization Name:WEIGUO LI, LLC
Other - Org Name:PENNSYLVANIA UNION MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WEIGUO
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-768-7168
Mailing Address - Street 1:625 CLARK AVENUE
Mailing Address - Street 2:SUITE 17A
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3065
Mailing Address - Country:US
Mailing Address - Phone:610-768-7168
Mailing Address - Fax:610-768-7169
Practice Address - Street 1:625 CLARK AVENUE
Practice Address - Street 2:SUITE 17A
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3065
Practice Address - Country:US
Practice Address - Phone:610-768-7168
Practice Address - Fax:610-768-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty