Provider Demographics
NPI:1760608004
Name:LI, WEI H (MD)
Entity Type:Individual
Prefix:
First Name:WEI
Middle Name:H
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 SEQUOIA DRIVE
Mailing Address - Street 2:PO BOX 3257
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352-3257
Mailing Address - Country:US
Mailing Address - Phone:909-336-5969
Mailing Address - Fax:
Practice Address - Street 1:1466 SEQUOIA DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-3257
Practice Address - Country:US
Practice Address - Phone:909-336-5969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34849171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor