Individual
JIM LI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 POLIFKA DR BLDG 1042, SHAW AFB, SC 29152-5100
(803) 895-6960
Mailing address
420 POLIFKA DR BLDG 1042, SHAW AFB, SC 29152-5100
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9473991-9921
UT
Other
Enumeration date
07/18/2015
Last updated
08/22/2024
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