Provider Demographics
NPI:1760574891
Name:LI-HIRASHIKI, VIVIAN Y (MD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:Y
Last Name:LI-HIRASHIKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:Y
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:139 CENTRE ST
Mailing Address - Street 2:SUITE 724
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4552
Mailing Address - Country:US
Mailing Address - Phone:212-334-2200
Mailing Address - Fax:212-334-2279
Practice Address - Street 1:139 CENTRE ST
Practice Address - Street 2:SUITE 724
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4552
Practice Address - Country:US
Practice Address - Phone:212-334-2200
Practice Address - Fax:212-334-2279
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02645283Medicaid
1512P1Medicare PIN
I21778Medicare UPIN