Provider Demographics
NPI:1972609063
Name:LI, DAVID HOP (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HOP
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 1:10185 JEAN ELLEN CT
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-9442
Mailing Address - Country:US
Mailing Address - Phone:408-846-9345
Mailing Address - Fax:
Practice Address - Street 1:80 GREAT OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1310
Practice Address - Country:US
Practice Address - Phone:408-363-3000
Practice Address - Fax:408-363-3088
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76500261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG76500OtherLICENSE
BL3818804OtherDEA LICENSE