Provider Demographics
NPI:1093990079
Name:YAN LI, MD., PHD., P.A.
Entity Type:Organization
Organization Name:YAN LI, MD., PHD., P.A.
Other - Org Name:OMNI MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-668-6868
Mailing Address - Street 1:4040 MCDERMOTT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7734
Mailing Address - Country:US
Mailing Address - Phone:972-668-6868
Mailing Address - Fax:972-668-1618
Practice Address - Street 1:4040 MCDERMOTT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7734
Practice Address - Country:US
Practice Address - Phone:972-668-6868
Practice Address - Fax:972-668-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1863171W00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00234WMedicare PIN