Provider Demographics
NPI:1841239399
Name:LI, ABEL (MD)
Entity Type:Individual
Prefix:
First Name:ABEL
Middle Name:
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 1:3902 CREEKSIDE LOOP
Mailing Address - Street 2:SUITE 110
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4876
Mailing Address - Country:US
Mailing Address - Phone:509-452-6611
Mailing Address - Fax:509-248-0621
Practice Address - Street 1:3902 CREEKSIDE LOOP
Practice Address - Street 2:SUITE 110
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4876
Practice Address - Country:US
Practice Address - Phone:509-452-6611
Practice Address - Fax:509-248-0621
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038596207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7735LIOtherREGENCE BLUESHIELD
WA8256760Medicaid
8933290OtherCRIME VICTIMS
G86711Medicare UPIN
WA8256760Medicaid