Active NPI
Chuan Li
- General Practice Dentistry
- Philadelphia, PA
National Provider Identifier
1417186925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6488-15
- Practice address
- 5675 N Front St Ste 50
Philadelphia, PA 19120 - Phone
- (617) 372-3902
- NPI assigned
- Jul 6, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6488-15 | WI | Primary |
Addresses
Primary practice location
5675 N Front St Ste 50
Philadelphia, PA 19120
Mailing address
2300N Mayfair Rd 920
Wauwatosa, WI 53226-1519
Phone (414) 257-1230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151124001739 | WI | Order and Referring Only - Dentist | 8022318062 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6488-15 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447891200000",
"number": "1417186925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300N MAYFAIR RD 920",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532261519",
"telephone_number": "414-257-1230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5675 N FRONT ST STE 50",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19120",
"telephone_number": "617-372-3902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LI",
"first_name": "CHUAN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-06",
"last_updated": "2015-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "6488-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.