Provider Demographics
NPI:1255856357
Name:LI, JIN YEE VIVIAN
Entity Type:Individual
Prefix:
First Name:JIN YEE
Middle Name:VIVIAN
Last Name:LI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 65TH PL
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5055
Mailing Address - Country:US
Mailing Address - Phone:646-244-1276
Mailing Address - Fax:
Practice Address - Street 1:4016 NATIONAL ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2321
Practice Address - Country:US
Practice Address - Phone:718-507-0442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist