Provider Demographics
NPI:1013362391
Name:LI, FREDERICK CONRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:CONRAD
Last Name:LI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:340 S LEMON AVE # 2318
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2706
Mailing Address - Country:US
Mailing Address - Phone:832-622-6212
Mailing Address - Fax:832-622-6212
Practice Address - Street 1:757 WESTWOOD PLZ STE 3325
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7419
Practice Address - Country:US
Practice Address - Phone:310-794-4494
Practice Address - Fax:310-267-3899
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2021-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA168284207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty