Provider Demographics
NPI:1497011233
Name:LI, JINGYI (MD)
Entity Type:Individual
Prefix:
First Name:JINGYI
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 BLEDSOE ST APT 2485
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2831
Mailing Address - Country:US
Mailing Address - Phone:281-788-7614
Mailing Address - Fax:
Practice Address - Street 1:9101 LBJ FWY STE 710
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1912
Practice Address - Country:US
Practice Address - Phone:972-792-5700
Practice Address - Fax:888-510-3225
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6869207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty