Provider Demographics
NPI:1952398562
Name:LI, GEORGE CHUNG (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:CHUNG
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST
Mailing Address - Street 2:STE 3000
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1521
Mailing Address - Country:US
Mailing Address - Phone:713-790-0841
Mailing Address - Fax:713-790-1350
Practice Address - Street 1:5115 FANNIN ST STE 801
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5870
Practice Address - Country:US
Practice Address - Phone:713-790-0841
Practice Address - Fax:713-790-9663
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG8243207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134594408Medicaid
TX134594405Medicaid
TX134594404Medicaid
TX134594405Medicaid
TX060051582OtherRR MEDICARE
TX87291GOtherBCBS
TX86790JMedicare PIN
TX8256B7Medicare PIN
TX87291GOtherBCBS
TXE56000Medicare UPIN
TX060051582Medicare PIN