Provider Demographics
NPI:1265799530
Name:LI, XIAODONG (MD &PHD)
Entity type:Individual
Prefix:
First Name:XIAODONG
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 1:314 MONTEREY RD UNIT 14
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3589
Mailing Address - Country:US
Mailing Address - Phone:858-252-5177
Mailing Address - Fax:
Practice Address - Street 1:314 MONTEREY RD UNIT 14
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030
Practice Address - Country:US
Practice Address - Phone:858-461-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134409207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty