Provider Demographics
NPI:1659899771
Name:LI, TOMMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
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 1:1388 BACON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-1638
Mailing Address - Country:US
Mailing Address - Phone:415-307-6520
Mailing Address - Fax:
Practice Address - Street 1:1388 BACON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-1638
Practice Address - Country:US
Practice Address - Phone:415-307-6520
Practice Address - Fax:415-307-6520
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1019161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty