Provider Demographics
NPI:1942654314
Name:LI, YIFAN (DO)
Entity Type:Individual
Prefix:
First Name:YIFAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:250 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1760
Mailing Address - Country:US
Mailing Address - Phone:270-781-7178
Mailing Address - Fax:270-796-5516
Practice Address - Street 1:250 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1760
Practice Address - Country:US
Practice Address - Phone:270-781-7178
Practice Address - Fax:270-796-5516
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY049772085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology