Individual
TIT S LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
819 W CESAR E CHAVEZ AVE, LOS ANGELES, CA 90012-2130
(213) 613-1255
(213) 613-1256
Mailing address
6181 GLENEAGLES CIR, HUNTINGTON BEACH, CA 92648
(714) 960-8245
(714) 960-8295
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A25684
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0002450
—
CA
Enumeration date
06/28/2006
Last updated
01/05/2009
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