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Organization
VICTOR LI MD A PROFESSIONAL MEDICAL
Active
Organization
VICTOR LI MD A PROFESSIONAL MEDICAL
Active
Other names
PRIME PAIN MEDICINE INSTITUTE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR LI MD (MD)
(831) 464-7246
Entity
Organization
Contact information
Practice address
4140 JADE ST, SUITE 102, CAPITOLA, CA 95010-3956
(831) 464-7246
(831) 576-2016
Mailing address
4140 JADE ST, SUITE 102, CAPITOLA, CA 95010-3956
(831) 464-7246
(831) 576-2016
Taxonomy
Speciality
Code
Description
License number
State
207LA0401X
Addiction Medicine (Anesthesiology) Physician
Primary
A77617
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A776170
BLUE SHIELD
CA
05
—
00A776170
—
CA
01
—
A77617
BLUE CROSS
CA
Enumeration date
12/05/2006
Last updated
10/30/2023
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