Provider Demographics
NPI:1457643181
Name:LI, YAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:YAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 KNICKERBOCKER RD
Mailing Address - Street 2:#18
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 KNICKERBOCKER RD
Practice Address - Street 2:#18
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2639
Practice Address - Country:US
Practice Address - Phone:646-287-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0562081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice