Provider Demographics
NPI:1659637460
Name:LI, WENHONG (MD)
Entity Type:Individual
Prefix:
First Name:WENHONG
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:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3516
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:1925 GLENN MITCHELL DR
Practice Address - Street 2:STE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0170
Practice Address - Country:US
Practice Address - Phone:757-689-8430
Practice Address - Fax:757-689-8435
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
VA0101256969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program