Provider Demographics
NPI:1245326826
Name:LI, KASEY KAICHI (MD, DDS)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:KAICHI
Last Name:LI
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-2212
Mailing Address - Country:US
Mailing Address - Phone:650-322-8588
Mailing Address - Fax:650-324-8339
Practice Address - Street 1:1900 UNIVERSITY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-2212
Practice Address - Country:US
Practice Address - Phone:650-322-8588
Practice Address - Fax:650-324-8339
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345161223S0112X
CAG74099174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered174400000XOther Service ProvidersSpecialist