Provider Demographics
NPI:1972640142
Name:LI, WEIGUO (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:WEIGUO
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S RAYMOND AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-7142
Mailing Address - Country:US
Mailing Address - Phone:626-943-1818
Mailing Address - Fax:
Practice Address - Street 1:25 S RAYMOND AVE STE 111
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-7142
Practice Address - Country:US
Practice Address - Phone:626-943-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A633080Medicaid
CA00A633080Medicaid
CAG66369Medicare UPIN