Individual provider Active NPI

Suk Y Li, DDS

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1235802455
Registry record updated Nov 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
106707 Issued in CA
Practice address
7821 Avalon Blvd
Los Angeles, CA 90003-2358
Phone
(323) 789-5610
NPI assigned
Jul 26, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 106707 CA Primary

Addresses

Primary practice location

7821 Avalon Blvd
Los Angeles, CA 90003-2358

Mailing address

7821 Avalon Blvd
Los Angeles, CA 90003-2358

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240207002782 CA Order and Referring Only - DentistPractitioner - Dentist 9638551484

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
106707CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
University Muslim Medical Association Inc CurrentSince Aug 25, 2024 Accepting new patients
University Muslim Medical Association Inc PastSince Nov 20, 2022 Accepting new patients

Locations

7821 Avalon Blvd
Los Angeles, CA 90003
Phone (323) 404-9270

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668556800000",
    "number": "1235802455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7821 AVALON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900032358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7821 AVALON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900032358",
            "telephone_number": "323-789-5610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LI",
        "first_name": "SUK",
        "middle_name": "Y",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-26",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "106707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.