Provider Demographics
NPI:1184857658
Name:XIN-NONG LI M.D., INC.
Entity Type:Organization
Organization Name:XIN-NONG LI M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XIN-NONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-961-3084
Mailing Address - Street 1:6600 MERCY CT
Mailing Address - Street 2:STE# 130
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3158
Mailing Address - Country:US
Mailing Address - Phone:916-961-3084
Mailing Address - Fax:916-961-3018
Practice Address - Street 1:6600 MERCY CT
Practice Address - Street 2:STE# 130
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3158
Practice Address - Country:US
Practice Address - Phone:916-961-3084
Practice Address - Fax:916-961-3018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH04886Medicare UPIN
CA00A675080Medicare PIN