Provider Demographics
NPI:1457969230
Name:LI, MIAO (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIAO
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14713 MOLISE CT
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4398
Mailing Address - Country:US
Mailing Address - Phone:859-629-5422
Mailing Address - Fax:
Practice Address - Street 1:757 N COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3944
Practice Address - Country:US
Practice Address - Phone:909-621-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29423103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist