Provider Demographics
NPI:1962467423
Name:NI, ANGELA LI (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LI
Last Name:NI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LI
Other - Middle Name:
Other - Last Name:NI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1535 W MERCED AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3404
Mailing Address - Country:US
Mailing Address - Phone:626-338-0811
Mailing Address - Fax:626-338-0922
Practice Address - Street 1:1535 W MERCED AVE
Practice Address - Street 2:STE 206
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3404
Practice Address - Country:US
Practice Address - Phone:626-338-0811
Practice Address - Fax:626-338-0922
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73365208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice