Provider Demographics
NPI:1437467123
Name:LI, YANLUN (DO)
Entity Type:Individual
Prefix:DR
First Name:YANLUN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BROOKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1040
Mailing Address - Country:US
Mailing Address - Phone:516-232-6839
Mailing Address - Fax:718-701-0877
Practice Address - Street 1:13630 MAPLE AVE STE 2H
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3868
Practice Address - Country:US
Practice Address - Phone:718-701-0589
Practice Address - Fax:718-701-0877
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270732207Q00000X
NYFAMILY MEDICINE390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program