Provider Demographics
NPI:1578629614
Name:LI, FENG-CHIA (DDS)
Entity Type:Individual
Prefix:
First Name:FENG-CHIA
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W VALLEY BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-2472
Mailing Address - Country:US
Mailing Address - Phone:626-282-5898
Mailing Address - Fax:626-282-5658
Practice Address - Street 1:1101 W VALLEY BLVD STE 206
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-2472
Practice Address - Country:US
Practice Address - Phone:626-282-5898
Practice Address - Fax:626-282-5658
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434591223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics