Provider Demographics
NPI:1720001357
Name:LI, XIAO FENG (MD)
Entity Type:Individual
Prefix:DR
First Name:XIAO
Middle Name:FENG
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11325 LAKE UNDERHILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5090
Mailing Address - Country:US
Mailing Address - Phone:407-275-0002
Mailing Address - Fax:407-275-0072
Practice Address - Street 1:11325 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5090
Practice Address - Country:US
Practice Address - Phone:407-275-0002
Practice Address - Fax:407-275-0072
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0703208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265082700Medicaid
FL379891700Medicaid
FL379891700Medicaid