Provider Demographics
NPI:1518987155
Name:LI, LAWRENCE BON YEN (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:BON YEN
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:PO BOX 62106
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93160-2106
Mailing Address - Country:US
Mailing Address - Phone:805-737-8700
Mailing Address - Fax:805-737-8701
Practice Address - Street 1:1225 N H ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3301
Practice Address - Country:US
Practice Address - Phone:808-737-8700
Practice Address - Fax:805-737-8701
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518987155OtherCOMMHLTHCENTERS, LOMPOC NPI#
CACMM7107FMedicaid
CAWG84878C W1508BMedicare PIN