Provider Demographics
NPI:1174742001
Name:LI, JANE YAN (OPTOMETRIST)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:YAN
Last Name:LI
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 MING AVE
Mailing Address - Street 2:SUITE L-2
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1318
Mailing Address - Country:US
Mailing Address - Phone:661-665-2020
Mailing Address - Fax:661-665-8820
Practice Address - Street 1:9000 MING AVE
Practice Address - Street 2:SUITE L-2
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1318
Practice Address - Country:US
Practice Address - Phone:661-665-2020
Practice Address - Fax:661-665-8820
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11692152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU88898Medicare UPIN