Individual
LEO LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
309 W BEVERLY BLVD, MONTEBELLO, CA 90640-4308
(818) 475-8014
(562) 696-4238
Mailing address
PO BOX 6359, WHITTIER, CA 90609-6359
(818) 475-8014
(562) 696-4238
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
G82244
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G822440
—
CA
01
—
954767156
TAX ID
CA
Enumeration date
02/13/2007
Last updated
03/12/2010
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