Provider Demographics
NPI:1124004965
Name:LI, JOHNNY T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:T
Last Name:LI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:7345 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE #280
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1937
Mailing Address - Country:US
Mailing Address - Phone:818-888-2855
Mailing Address - Fax:818-888-0702
Practice Address - Street 1:7345 MEDICAL CENTER DR
Practice Address - Street 2:SUITE #280
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1937
Practice Address - Country:US
Practice Address - Phone:818-888-2855
Practice Address - Fax:818-888-0702
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA025311207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A253110Medicaid
CAY5394OtherMEDICARE SUPPLIER #
CAA025311OtherCA MEDICAL LICENSE
CA953718732OtherCORPORATE TAX ID
CA00A253110Medicaid
CA953718732OtherCORPORATE TAX ID