Provider Demographics
NPI:1841999166
Name:LI, SAM S (DC)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:S
Last Name:LI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2436 JUDAH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1436
Mailing Address - Country:US
Mailing Address - Phone:415-682-0706
Mailing Address - Fax:415-707-6800
Practice Address - Street 1:2436 JUDAH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1436
Practice Address - Country:US
Practice Address - Phone:415-682-0706
Practice Address - Fax:415-707-6800
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-26429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor