Provider Demographics
NPI:1225531007
Name:LI, ALVIN
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N LAKE SHORE DR APT 1404
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3995
Mailing Address - Country:US
Mailing Address - Phone:408-510-2791
Mailing Address - Fax:
Practice Address - Street 1:136 N SAN MATEO DR FL 2
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2778
Practice Address - Country:US
Practice Address - Phone:650-348-1242
Practice Address - Fax:650-348-0788
Is Sole Proprietor?:No
Enumeration Date:2018-03-17
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.073474207N00000X
CAA176382207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology