Provider Demographics
NPI:1437293750
Name:LI, JOB (MD)
Entity Type:Individual
Prefix:
First Name:JOB
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15206 PARTHENIA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-5305
Mailing Address - Country:US
Mailing Address - Phone:818-895-3100
Mailing Address - Fax:818-893-9464
Practice Address - Street 1:15206 PARTHENIA ST
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5305
Practice Address - Country:US
Practice Address - Phone:818-895-3100
Practice Address - Fax:818-893-9464
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70436FMedicaid
CAEAP70436FMedicaid
CAW11698OtherGROUP ID
CAFHC70436FMedicaid